Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jun 2023
Randomized Controlled Trial Multicenter StudyThe effects of tourniquet on cement penetration in total knee arthroplasty.
Aseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant's "strength" and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients. ⋯ Tourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.
-
Arch Orthop Trauma Surg · Jun 2023
ReviewThe iliac stemmed cup in reconstruction of the acetabular defects secondary to tumor resection: a systematic review of literature.
Stemmed acetabular cups are suitable for reconstruction in case of important bone loss. Nevertheless, their use is not so common, because generally judged very invasive and technically difficult to implant. The aim of the present review is to verify the results of their use and to evaluate indications and complications. ⋯ Data regarding SAC prostheses are quite rare in the literature; no prospective studies with comparisons with other reconstruction techniques are available so their use is mainly based on the experience of single centers. While data for tumors are more consistent and supported by studies, information on revisions of hip prosthesis implanted for degenerative problems is quite scarce. Preliminary results on the SAC prosthesis as a valid alternative both for tumoral and degenerative revision cases are encouraging. Prospective randomized studies are advocated to value results compared to alternative techniques.
-
Arch Orthop Trauma Surg · Jun 2023
Randomized Controlled TrialThe minimal clinically important difference (MCID) of the Olerud Molander Ankle Score (OMAS) in patients with unstable ankle fracture.
The Olerud Molander Ankle Score (OMAS) is a widely used validated Patient Reported Outcome Measure (PROM). For clinical research, it is important to determine the Minimal Clinically Important Difference (MCID). The objective of this study was to determine the MCID of the OMAS at several moments in the follow-up, in a cohort of patients that underwent open reduction and internal fixation of unstable ankle fractures with syndesmotic injury. ⋯ The calculated MCID in patients following surgery for unstable ankle fractures ranges from 10.5 to 15.0 at 3-6-month follow-up and from 7.5 to 11.4 at 6-12-month follow-up, depending on moment and method.
-
Arch Orthop Trauma Surg · Jun 2023
ReviewConversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review.
With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly extracapsular hip fractures are treated with either cephalomedullary nails (CMNs) or sliding hip screws (SHS). ⋯ Conversion total arthroplasty is a technically demanding and resource-intensive surgery associated with lower success rates and outcomes than primary total hip arthroplasty. Orthopedic surgeons should have thorough understanding of preoperative workup needed prior to surgery, implant selection associated with best outcomes, most common surgical approaches used, intraoperative considerations, and complications associated with conversion total hip arthroplasty. A comprehensive understanding of these concepts gives patients the best chance of having a successful outcome.
-
Arch Orthop Trauma Surg · Jun 2023
ReviewAcetabular fixation in total hip arthroplasty in the previously irradiated pelvis: a review of basic science and clinical outcomes.
Radiation therapy is a common primary, adjuvant, or palliative treatment for many intrapelvic tumors, including primary gastrointestinal, genitourinary, and hematopoietic tumors, as well as metastatic disease to bone. Radiation has well documented microbiologic and clinical effects on bone ranging from radiation osteitis to early degenerative changes of the hip joint and avascular necrosis of the femoral head. ⋯ With limited evidence, trabecular metal shells with multi-screw fixation and cemented polyethene liners, as well as cemented cup-cage constructs both appear to be durable acetabular fixation options, though the indications for each remains elusive. Further prospective data are needed to better characterize this difficult clinical problem.