Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2023
Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5.
Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. ⋯ For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Arch Orthop Trauma Surg · Apr 2023
Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?
Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. ⋯ The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.
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Arch Orthop Trauma Surg · Apr 2023
Iliac dysmorphism: defining radiographic characteristics and association with pelvic osseous corridor size.
Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor. ⋯ This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.
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Arch Orthop Trauma Surg · Apr 2023
Validation of the distal filling ratio in uncemented convertible short-stem shoulder arthroplasty.
Radiographic stress shielding is a common finding in uncemented convertible short-stem shoulder arthroplasty (UCSSSA). The distal filling ratio (DFR) has been described as a predictor for the occurrence of stress shielding. A DFR > 70% was mentioned as a risk factor for the occurrence of stress shielding for some UCSSSA. However, measurements were only performed on conventional radiographs and no validation exists for 3D automated planning tools. ⋯ Level IV, retrospective study.
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Arch Orthop Trauma Surg · Apr 2023
How does systemic lupus erythematosus impact the peri-operative complication rates in primary hip arthroplasty? A national inpatient sample-based study.
With prolonged life expectancy, the number of patients with systemic lupus erythematosus (SLE) undergoing total hip arthroplasty (THA) has substantially increased over the past years. The post-operative outcome and complications in SLE are less clearly understood than other inflammatory diseases, due to limited availability of evidence within the literature. ⋯ The presence of SLE significantly lengthens hospital stay and augments healthcare-related costs in patients undergoing THA. The three main complications which may significantly affect the post-operative course of these patients include higher rates of post-operative anemia, peri-prosthetic infections, and early prosthetic dislocations.