3 research outputs found
Revision of migrated pelvic acetabular components in THA with or without vascular involvement
Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8) total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4) of these cases. Two (2) cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views), CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6) units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace) in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions
Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis
Objectives Late first-stage or second-stage cesarean section is commonly
associated with fetal head impaction, leading to maternal and neonatal
complications. This situation requires safe delivery techniques, but the
optimal management remains controversial. The aim of this meta-analysis
was to compare maternal and neonatal outcomes associated with delivery
techniques via cesarean section. Methods An electronic search of three
databases, from inception to June 2021, was conducted. Cohort and
randomised comparative studies on maternal and neonatal outcomes
associated with techniques to deliver an impacted fetal head during
cesarean section were included. The methodological quality of the
primary studies was assessed. Review Manager 5.4 was used for
statistical analyses. Results Nineteen articles, including 2,345 women
were analyzed. Three fetal extraction techniques were identified.
Meta-analyses showed that the “pull” technique carries lower risks
as compared to the “push” technique and the “Patwardhan”
technique is safer compared to the “push” or the “push and pull”
technique. Conclusions In the absence of robust evidence to support the
use of a specific technique, the choice of the obstetrician should be
based on best available evidence. Our study suggests that the
“pull”, as well as the “Patwardhan” technique represent safe
options to deliver an impacted fetal head