Fusion rate of 89% after knee arthrodesis using an intramedullary nail: a mono-centric retrospective review of 48 cases.

PURPOSE: Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate. METHODS: A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2™ Arthrodesis Nail, 6 OsteoBridge® Knee Arthrodesis and 27 Wichita® fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6-18 years). RESULTS: Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita® fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%). CONCLUSION: Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita® fusion nail shows a tendency to better results compared to the two other nails. LEVEL OF EVIDENCE: Case series, level IV.

Total hip arthroplasty through the direct anterior approach with and without the use of a traction table: a matched-control, retrospective, single-surgeon study.

BACKGROUND: Hip surgeons performing total hip arthroplasty (THA) through the direct anterior approach (DAA) commonly use a traction table to facilitate exposure. Even though performing THA through DAA without a traction table could be technically more demanding, this technique offers the advantage of intraoperative leg length comparison. Therefore, this study aimed to compare clinical outcomes, complication rates, component positioning, and leg length discrepancy (LLD) after THA through the DAA performed with or without a traction table. METHODS: A single-surgeon continuous series of 75 patients who underwent DAA THA performed with a traction table was matched for gender, age, and BMI with 75 patients who underwent DAA THA performed without a traction table (male, 62; female, 88, with an average age of 68 years old). Clinical and radiological outcomes, intra- and postoperative complications, and LLD were retrospectively assessed. RESULTS: No statistically significant difference was detected in surgical time, hospital stay, Harris Hip Score (HHS), complication rates, and implant positioning between the two groups. Leg length restoration was significantly more accurate in the group performed without a traction table (2.4 ± 2 mm vs. 3.7 ± 3.1 mm; p value ≤ 0.05). No LLD > 10 mm was reported in the group performed without a traction table, whereas two cases (2.7%) were reported in those performed with a traction table. CONCLUSION: Performing THA through DAA without a traction table was associated with a significantly more accurate leg length restoration without a significant increase in the rates of intra- and postoperative complications.

Are there more wound complications or infections with direct anterior approach total hip arthroplasty?

INTRODUCTION: Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. METHOD: We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections. RESULTS: Of the 796 patients in the PA group, there were 6 wound complications leading to reoperation and 6 infections; 4 early and 2 delayed onset. Among the infected cases, one was obese (body mass index [BMI] >30 kg/m2). Two procedures were teaching-based. Of the 399 patients in the DAA group, there were three dehiscences leading to reoperation, two of which were in obese patients. 6 infections were also found; 4 with early and 2 with delayed onset. Of the infected cases, three were obese. 4 procedures were teaching-based. CONCLUSION: In our series of patients undergoing THA, the DAA did not increase the rates of either wound complications leading to reoperation nor early or delayed infection compared to the PA.

[Patients with metal-on-metal hip arthroplasty: evaluation and management of complications]. / Suivi des patients avec arthroplastie de hanche métal-métal et stratégie de prise en charge des complications.

The potentially severe complications related to metal-on-metal (MoM) hip replacements have led to a dramatic decrease of their use. Large diameter heads are more likely to fail than smaller diameters, but complications have been described even with « small ¼ diameters. Therefore, monitoring of MoM arthroplasties is mandatory. This includes physical examination, X-Rays, metal ion levels, and potentially cross-sectional imaging. Despite pathophysiology of adverse reactions to metal debris (ARMD) is better understood, their evolution and the potential systemic complications remain unclear. Symptomatic hip arthroplasties, elevated ions levels, and ARMD may lead to revision of the components. In such a situation, an adaquate stategy must be achieved given the high potential for complications.

Les complications potentiellement graves des arthroplasties de hanche métal-métal (MoM) expliquent la diminution spectaculaire de leur implantation. Ces complications sont plus fréquentes pour les têtes de grand diamètre, mais sont possibles avec de « petites ¼ têtes. Une surveillance des arthroplasties MoM s'impose donc. Elle implique un examen clinique, des radiographies, des dosages d'ions chrome et cobalt, et éventuellement une imagerie spécialisée. Si la physiopathologie des réactions indésirables aux débris métalliques (ARMD) est mieux appréhendée, leur évolution et les possibles complications systémiques sont moins connues. La présence de symptômes, de dosages d'ions élevés, d'ARMD peut conduire à une révision des implants. Une stratégie chirurgicale rigoureuse est alors indispensable car les complications sont fréquentes.

[Prevention of perioperative infections in orthopaedic surgery - Role of general practitioner]. / Prévention des infections périopératoires en orthopédie : le rôle du médecin généraliste.

Total joint replacement comes with a high success rate and has been shown to have a very positive impact on our patients suffering from arthritis. Against all efforts about 2 % of our patients will suffer an implant related infection. As the treatment of infected arthroplasties is difficult and expensive the knowledge of risk factors is becoming more and more important for the treatment team in order to improve our preventive measures. Prevention must be performed pre-, intra- and postoperatively. Preoperative optimization of blood sugar levels, nutritional status and correction of general anaemia for example are paramount and the general practitioner as well as the surgeon should be aware of these and other modifiable risk factors in order to operate on the patient in the best possible conditions.

La chirurgie prothétique est une chirurgie dont l'impact est extrêmement favorable pour nos patients souffrant d'une arthrose. Malgré des progrès considérables pour diminuer le taux d'infections postopératoires, cette complication grave survient dans encore environ 2 % des cas. La prévention joue un rôle très important pour diminuer l'incidence de ces infections, à la fois en pré, péri et postopératoire. Le chirurgien et le médecin traitant doivent connaître, rechercher et prendre en charge les facteurs de risque connus d'infection avant toute chirurgie orthopédique. Les principaux facteurs de risque souvent modifiables comme les hyperglycémies, les anémies et la dénutrition seront discutés dans cet article.

[Ten errors to avoid while dealing with infected total joint arthroplasties]. / Dix erreurs a ne pas commettre lors de la prise en charge d'une prothèse articulaire infectée en orthopédie.

Infections after total joint arthroplasty are rare but come with severe consequences. Timely, adequate and standardized treatment beginning at the onset of symptoms will have a major impact on the handling of this dreaded complication. In absences of clear guidelines, errors are often committed, with occasionally severe consequences for the patient. In this article, the 10 most frequent errors starting with diagnostics till antibiotic and surgical treatment will be discussed.