Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

Background: Trochanteric osteotomies (TO) facilitate exposure and "true hip reconstruction” in complex primary and revision total hip arthroplasty (THA). However, non-union represents a clinically relevant complication. The purpose of the present study was to identify risk factors for trochanteric non-union. Methods: All cases of THA approached by TO during the past 10years were analyzed with respect to potential risk factors for non-union. Results: In 298 cases complete data were available for analysis. Trochanteric union occurred in 80.5%, fibrous union in 5.4% and non-union 14.1%. Risk factor analysis revealed a four times higher risk for non-union in anterior trochanteric slide osteotomies compared to extended trochanteric osteotomies and a three times higher risk in cemented versus non-cemented stems. Multiple logistic regression analysis revealed patient's age and use of cement to be independent risk factors for non-union. Conclusions: Femoral cementation and increasing age negatively influence the union of trochanteric osteotomie

Total hip replacement in patients with history of illicit injecting drug use

Background: A history of illicit injecting drug use makes indication of total hip arthroplasty (THA) in patients with end stage hip osteoarthritis difficult, as the risk of infection with colonized strains is multiplied if the patient continues to inject or inhale illicit drugs. Methods: A retrospective survivorship analysis of a consecutive series of 27 THA in patients with a history of illicit drug use was performed. Follow-up evaluation consisted of (1) a WOMAC score, (2) a standardized interview including queries on drug habits and eventual additional medico-surgical treatments of the affected hip, (3) a clinical examination in order to complete a Harris Hip Score, (4) radiological examination and (5) blood tests (blood sedimentation rates and C-reactive protein). Defined endpoints were death, implant revised or awaiting revision for deep infection or any other reason and lost to follow-up or follow-up after at least 2years. Results: Overall, 5- and 10-year implant survival rates with failure for any reason were 61% (CI: 41;81) and 52.3% (CI: 29;76) and for septic reasons 70.6% (CI: 52;89) and 60.5% (CI: 36;85), respectively. Even if at the time of THA all patients and respective health care professionals confirmed abstinence of illicit injecting drug use, five patients reported occasional use. Declared abstinence of less than 1year before THA was associated with higher recurrence rates (p=0.001) and both with higher septic failure rates (p=0.023, p=0.061). Positive serology for human deficiency virus did not increase implant failure rates. Conclusion: We use this unacceptable high failure rate as evidence when counseling patients and their health care professionals about the appropriate treatment of osteoarthritis in patients with a history of illicit drug use. Furthermore, we support the request of hair analysis for drugs documenting abstinence of at least 1year before indicating TH

Ultrasound for the evaluation of femoroacetabular impingement of the cam type. Diagnostic performance of qualitative criteria and alpha angle measurements

Objective: To develop and assess a technique to evaluate cam type femoroacetabular impingement (FAI) using ultrasound (US). Methods: Fifty patients (24 women, 26 men) were included (mean age: 39.1years; age range: 16-59). US images of the anterior and anterosuperior contour of the femoral neck were obtained and analysed in 50 patients. Non-spherical shape of the head-neck junction (cam deformity), bony protuberances at the femoral neck, shape of the femoral neck (waist deficiency) and alpha angle were assessed. Magnetic resonance (MR) arthrography served as the standard of reference. Diagnostic performance and receiver operating characteristics (ROC) curves were calculated. Results: Based on MR arthrography 28 patients had cam-type FAI. On US, an anterosuperior cam deformity was seen in 40/44 patients (Reader 1/Reader 2; sensitivity 93%/89%, specificity 36%/14%). A bony protuberance anterosuperiorly in 23/13 patients (sensitivity 71%/32%, specificity 86%/82%) and an anterosuperior waist deficiency in 19/35 patients (sensitivity 25%/54%, specificity 100%/54%). Sensitivity and specificity of the other criteria were lower than 70% (average of Reader 1 & 2). Conclusion: A technique to evaluate cam type FAI using US is presented. The detection of an anterosuperior cam deformity is sensitive, and presence of an anterosuperior bony protuberance is specific for cam FAI. Alpha angle measurements are not helpful in establishing the diagnosi

Outcome after proximal femoral fractures during primary total hip replacement by the direct anterior approach

Background: The literature suggests that intraoperative fractures of the greater trochanter and the metaphysis are increased with uncemented stems and the direct anterior approach. This study aims to determine the incidence and assess the functional and radiological outcome after such fractures. Methods: 484 consecutive total hip replacements (THR) (64±12years) were analyzed. We treated trochanteric fractures conservatively without any further denuding, and secured metaphyseal fissures with cerclages. Postoperative X-rays and at the latest follow-up were compared to assess secondary fracture displacement and stem subsidence. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after 1year were analyzed. For each patient sustaining a fracture, two patients without fractures were matched in terms of age, body mass index and gender. Results: 13 (2.7%, 5 male, 68±9years) patients with intraoperative fractures of the greater trochanter (n=8) or the metaphysis (n=5) were analyzed. Consolidation was observed in 7/8 patients sustaining a trochanteric fracture while secondary displacement of the fragment occurred in one case. Stem subsidence was observed in 2/5 cases (5 and 7mm). Patients who sustained a fracture showed a trend towards poorer WOMAC scores at 1year postoperatively, compared to patients without fractures. A significantly increased joint stiffness was also observed. Conclusion: The intraoperative fracture risk in this series of THR through a direct anterior approach was 2.7%. Trochanteric fractures do heal without primary fixation. Metaphyseal fractures heal well if immediately stabilized with a cerclag

Does previous hip arthroscopy negatively influence the short term clinical result of total hip replacement?

Introduction: The risk that hip preserving surgery may negatively influence the performance and outcome of subsequent total hip replacement (THR) remains a concern. The aim of this study was to identify any negative impact of previous hip arthroscopy on THR. Methods: Out of 1271 consecutive patients who underwent primary THR between 2005 and 2009, 18 had previously undergone ipsilateral hip arthroscopy. This study group (STG) was compared with two control groups (CG, same approach, identical implants; MCG, paired group matched for age, BMI and Charnley categories). Operative time, blood loss, evidence of heterotopic bone and implant loosening at follow-up were compared between the STG and the MCG. Follow-up WOMAC were compared between the three groups. Results: Blood loss was not found to be significantly different between the STG and MCG. The operative time was significantly less (p<0.001) in the STG. There was no significant difference in follow-up WOMAC between the groups. No implant related complications were noted in follow-up radiographs. Two minor complications were documented for the STG and three for the MCG. Conclusion: We have found no evidence that previous hip arthroscopy negatively influences the performance or short-term clinical outcome of TH

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Introduction: Wondering if the use of drains allowing re-transfusion of shed blood as opposed to closed suction drains or no drains would improve quality of care to patients undergoing simple non-cemented primary total hip replacement (THR) using a direct anterior approach, a three-arm prospective randomized study was conducted. Method: One hundred and twenty patients were prospectively randomized to receive no drain, closed suction drains or drains designed for re-transfusion of shed blood. Blood loss, VAS pain scores, thigh swelling, hematoma formation, number of dressings changed and hospital stay were compared and patients followed for 3months. Results: Drains did not have any significance on postoperative haemoglobin and haematocrit levels or homologous blood transfusion rates. Patients receiving homologous blood transfusions had too small drain volumes to benefit from re-transfusion and patients, who get drained fluid re-transfused, were far away from being in need of homologous blood transfusion. Omitting drains resulted in more thigh swelling accompanied with a tendency of slightly more pain during the first postoperative day but without effect on clinical and radiological outcome at 3months. Earlier dry operation sites resulting in simplified wound care and shorter hospital stay was encountered when no drain was used. Conclusion: The possibility to re-transfuse drained blood was not an argument for using drains and, accepting more thigh swelling, we stop to use drains in simple non-cemented primary THR using the direct anterior approac

Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations

Introduction: Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage. Materials and methods: Hundred patients scheduled for primary THR were randomly assigned for CSD or non-drainage. Drains were withdrawn at day2. Pain, wound hematoma, number of dressing changes, time of persistent discharge from the operation site (skin incision and drain hole), total blood loss and number of blood transfusions were prospectively recorded. Hip function, presence of heterotopic ossifications (HTO) and complications were recorded at a follow visit 1year after surgery. Results: Wound sites managed without CSD needed significantly less wound dressings (P<0.001) and were dry at an earlier time (P<001). Despite a significant bigger subfascial hematoma in the non-drained group (P<0.05), in terms of pain, thigh swelling, total blood loss, number of transfusions needed, hip function and HTO no difference was recorded between the groups (P=0.2-0.82). Conclusion: To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long ter

Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results

Introduction: Surgical hip dislocation (SHD) is an accepted standard to treat femoroacetabular impingement (FAI). However, arthroscopic techniques have gained widespread popularity and comparable results are reported. The purpose of this prospective comparative study was to test the hypothesis that, when compared to SHD, hip arthroscopy (HA) results in faster recovery, better short-term outcome, and equivalent morphological corrections. Materials and methods: 38 patients presenting with clinically and morphologically verified isolated FAI were allocated to either HA or SHD. Morphological evaluation consisted of pre- and postoperative X-rays, and arthro-MRI. Demographic data, sport activities, hospital stay, complications, and the time off work were recorded. The subjective hip value, WOMAC, HHS, and hip abductor strength were measured up to 1year. Results: Shorter hospital stay and time off work, less pain at 3months and 1year, higher subjective hip values at 6weeks and 3months, and better WOMAC at 3months were seen after HA. The HHS and the hip abductor strengths were higher in the HA group. However, morphological corrections at the head-neck-junction achieved by HA showed some overcorrection when compared to SHD. Labral refixation was performed less frequent in the HA group. Conclusion: When compared to SHD, HA results in faster recovery and better short-term outcome. However, some overcorrection of the cam deformity and limited frequency of labrum refixation with HA in this study may have a negative impact on long-term outcom

Diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis

Purpose: To retrospectively evaluate the diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Methods: Thirty-three partial body 18F-FDG PET/CT scans were performed in 33 patients with trauma suspected of having chronic osteomyelitis. In 10 and 23 patients, infection was suspected in the axial and appendicular skeleton, respectively. In 18 patients, PET/CT was performed in the presence of metallic implants. Histopathology or bacteriological culture was used as the standard of reference. For statistical analysis, sensitivity, specificity and accuracy were calculated in relation to findings of the reference standard. Results: Of 33 PET/CT scans, 17 were true positive, 13 true negative, two false positive and one false negative. Eighteen patients had chronic osteomyelitis and 15 had no osseous infection according to the reference standard. Sensitivity, specificity and accuracy for 18F-FDG PET/CT was 94%, 87% and 91% for the whole group, 88%, 100% and 90% for the axial skeleton and 100%, 85% and 91% for the appendicular skeleton, respectively. Conclusion: 18F-FDG PET/CT is a highly sensitive and specific method for the evaluation of chronic infection in the axial and appendicular skeleton in patients with trauma. PET/CT allows precise anatomical localisation and characterisation of the infectious focus and demonstrates the extent of chronic osteomyelitis with a high degree of accurac

Visualización de la percepción del espacio urbano

En este trabajo se propone elaborar una herramienta gráfica para visualizar la percepción urbana. En particular se busca representar la percepción que tienen los habitantes de la ciudad de Río Gallegos según un sondeo estadístico efectuado recientemente. La imagen de la ciudad está conformada por una visión global de la misma, la relación entre sus elementos, y las reacciones ante apreciaciones prácticas o afectivas. El objetivo final es implementar una herramienta capaz de representar visualmente los resultados obtenidos (expresados absolutamente como datos estadísticos), de manera que se pueda tener más claramente una idea global de una ciudad como espacio vivido y el comportamiento de los habitantes a través de esta imagen, para determinar las condiciones de la ciudad, sus cualidades, sus defectos, preocupaciones particulares, vida en común, utilización, conocimiento e integración de los elementos.Eje: Programación de imágenesRed de Universidades con Carreras en Informática (RedUNCI