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

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

Objective: To evaluate the association between hypertrophy of the tensor fasciae latae muscle and abductor tendon tears. Materials and methods: Thirty-five patients who underwent MRI of the abductor tendons of the hip were included in this retrospective study. A subgroup of 18 patients was examined bilaterally. The area of the tensor fasciae latae muscle and the area of the sartorius muscle (size reference) were quantified at the level of the femoral head, and a ratio was calculated. Two radiologists assessed the integrity of the gluteus medius and minimus tendon in consensus. Data were analyzed with a Mann-Whitney U test. Results: Sixteen out of 35 patients (46%) had a tear of the gluteus medius or minimus tendon. The ratio of the area of the tensor fasciae latae to the sartorius muscle was significantly higher (p = .028) in the group with an abductor tendon tear (median 2.25; Interquartile Range [IQR] = 1.97-3.21) compared to the group without any tears (median 1.91; IQR = 1.52-2.26). The bilateral subanalysis showed that in patients without a tear, the ratio of the two areas did not differ between each side (p = .966), with a median of 1.54 (primary side) and 1.76 (contralateral side). In patients with an abductor tendon tear the ratio was significantly higher (p = .031) on the side with a tear (median 2.81) compared to the contralateral healthy side (1.67). Conclusion: Patients with abductor tendon tears showed hypertrophy of the tensor fasciae latae muscle when compared to the contralateral healthy side and to patients without a tea

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

L5-S1 Discoligamentous Distraction Injury following Bilateral Total Hip Arthroplasty Using an Anterior Approach: A Case Report

<jats:p>Although acute spinal injury is rarely reported to complicate total hip arthroplasty (THA), its consequences can be devastating. We present a case of L5-S1 discoligamentous dissociation following single-stage bilateral THA performed sequentially through an anterior approach with a traction hemi-table applied on the operated leg. Internal fixation L5-S1 was required, resulting in prolonged recovery, but without relevant long-term sequelae. Pre-operative assessment of the spine is recommended when considering these procedures to evaluate the risk for this potentially severe complication. Particularly, lateral position may be favoured to avoid extension stresses of the spine. An anterior approach may have to be avoided, as it requires hyperextending the hip. A staged procedure may also be preferred to a single-anaesthesia bilateral procedure, limiting duration of potentially harmful positioning. </jats:p&gt

Hip abductor damage on MRI.

<p>Shown is the coronal T1-weighted MR-image at the level of the greater trochanter of a 72 year old female patient, complaining of severe lateral hip pain on the left side, radiating down to the knee. The greater trochanter is very tender on palpation and the patient presents with a reduced walking distance and difficulties during the gait cycle. The Hip Lag Sign was positive on the left side.</p

The Hip Lag Sign.

<p>Shown is the Hip Lag Sign as it is defined in this work: To test for the Hip Lag Sign, the patient has to lie in a lateral, neutral position with the affected leg being on top. The examiner then positions one arm under this leg to have good hold and control over the relaxed extremity, whereas the other hand stabilizes the pelvis. The next step is to passively extend to 10° in the hip, abduct and rotate internally as far as possible, while the knee remains in a flexed position of 45°. After the patient is asked to hold the leg actively in this position, the examiner releases the leg. The Hip Lag Sign is considered positive, if the patient is not able to keep the leg in the aforementioned abducted, internally rotated position and the foot drops more than 10 cm.</p

Shown are the patients' characteristics of all included cases.

<p>(BMI = Body Mass Index; Hip Lag Sign = Hip Lag Sign; cl Hip Lag Sign = contralateral Hip Lag Sign; mHHS = modified Harris Hip Score; VAS = visual analogue scale; PR = partial rupture; R = rupture).</p

Shown is the categorisation of the study population in four outcome subgroups regarding the modified Harris Hip Score.

<p>There is no significant clustering (p = 0.195 [Chi²] for abductor damage; p = 0.701 [Chi²] for Hip Lag Sign result).</p

Flow Chart.

<p>Shown is the flow of patients through the Hip Lag Sign-study according to STARD-Guidelines.</p