Trabecular metal cup without augments for acetabular revision in case of extensive bone loss and low bone-prosthesis contact.

Current evidences in revision hip arthroplasty suggest to treat severe acetabular bone loss with dedicated implants, such as anti-protrusio cages, stemmed cups, modular systems supplied with iliac flanges and obturatory hook. However recent literature is reporting satisfactory outcomes with simple elliptical Trabecular Metal cups. Purpose of the study was to evaluate mid-term results of such a surgical procedure. All hip revisions performed from 2008 to 2009 with implantation of a TMT multi-hole acetabular cup without augmentations were retrospectively reviewed. The cases with low-degree acetabular bone loss (stage I and II according to GIR classification), with surgical report poorly describing the bone defect, with inadequate pre- and post-operative x-rays were ruled out. Twenty-five cases were identified, but four were lost to follow-up. The twenty-one patients were 71 year-old on average (from 60 to 82), with stage IV bone loss in 6 cases and stage III bone loss in 15 cases. Mean interval from surgery to evaluation was 20.9 months (from 13 to 30). The evaluation included bone-prosthesis contact estimation, component position, survivorship, complications, final Harris Hip Score, presence of periprosthetic radiolucencies. Host bone-prosthesis contact was estimated to be about 35%. Only three implant were subsequently reoperated (for infection, early migration, recurrent dislocation). The HHS among non-reoperated 18 patients was 81.96 on average (from 63.44 to 95.82). Six cases showed thin radiolucencies in one of the three Charnley zones, while three cases showed radiolucencies in two. None of these images was evolutive, thus they were not considered signs of loosening. The mid-term results of this series confirm the hypothesis that a porous tantalum acetabular cup is an effective option to deal with difficult acetabular revisions. Although no extra-acetabular fixation device is available, the very high surface friction guaranteed by the material and the supplemental stability provided by trans-acetabular screws seem to be sufficient to allow satisfactory reimplantation even in severely damaged pelves

How to write an original article for the Journal of Orthopaedics and Traumatology

The abstract is the precise summary of the article, not a preface. As Baue wrote in a popular editorial of the Archives of Surgery in 1979, “writing a good abstract is not abstract writing” [6]. The main data have to be represented, as they allow readers to understand contents clearly. Sentences like “The paper reports...” or “The authors describe...” have to be avoided as well as any generic statements

First results with the immediate reconstructive strategy for internal hardware exposure in non-united fractures of the distal third of the leg : case series and literature review

Background: Fractures of the distal third of the leg are increasingly common and are often handled by open reduction and internal fixation. Exposure and infection of internal hardware could occur, especially after high energy traumas, requiring hardware removal and delayed soft tissue reconstruction. Nevertheless immediate soft tissue reconstruction without internal hardware removal is still possible in selected patients.In this study the effectiveness and the complications of immediate soft tissue reconstruction without internal hardware removal is analyzed.Methods: 13 patients, affected by internal hardware exposure in the distal leg, treated with immediate soft tissue reconstruction with pedicled flaps and hardware retention, are retrospectively analyzed, with special regard to flap survival and wound infection.Results: Wound infection was observed in 10 cases before surgery and in 5 cases surgical debridement was necessary before reconstruction which was performed in a separate operative session.After reconstruction, wound dehiscence and infection occurred in 5 cases, and in 3 cases removal of internal hardware was necessary in order to achieve the complete healing of dehiscence. In one case the previous flap failed but prompt reconstruction with a sural fasciocutaneous flap was performed without hardware removal and without complications. Pre-operative infection and late reconstructive surgery are predictive for higher rates of post-operative complications (respectively p 0.018 and p 0.028).Conclusion: Our approach achieved full recovery in 53.8% of the treated cases after one-step surgery, therefore reducing hospitalization and allowing early mobilization. Controlled trials are needed to confirm the effectiveness of this strategy, although the present case series shows encouraging results

The Italian Consensus Conference on FAI Syndrome in Athletes (Cotignola Agreement)

Background. Femoro-acetabular impingement (FAI) is an important topic in literature because of its strong relationship with sport populations. Methods. Sixty-five experts participated in "this Consensus Conference (CC)". They discussed, voted and approved a consensus document on the FAI syndrome in athletes. Results. The CC experts approved document provided suggestions concerning: 1) Epidemiology of FAI; 2) Clinical evaluation; 3) Radiological evaluation; 4) Conserva-tive treatment; 5) Surgical criteria; 6) Surgical techniques; 7) Post-surgical rehabilita-tion; 8) Outcome evaluation; 9) FAI-associated clinical frameworks. Conclusions. The CC offers a multidisciplinary approach to the diagnosis and treat-ment of FAI syndrome in athletes taking into account all the different steps needed to approach this pathology in sport populations