Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Oct 2024
Modified notching classification in inverted-bearing and conventional-bearing reverse total shoulder arthroplasty.
Scapular notching is a common complication of reverse total shoulder arthroplasty (RTSA). Although the notching rate has reduced significantly thanks to modifications to the surgical technique and humeral and glenoid components, uncontrollable polyethylene (PE)-induced osteolysis can still occur. In contrast to conventional-bearing (CB-RTSA), inverted-bearing RTSA (IB-RTSA) systems, with PE glenospheres and metal or ceramic humeral liners, avoid PE abrasion through scapulohumeral contact. If present, the resulting notch has a different size and configuration than with CB-RTSA. Thus, a modified notching classification seems reasonable. Even in CB-RTSA, the early stages of notching show a different configuration than implied by the established Nerot-Sirveaux classification; therefore, a modification of the classification system is recommended. ⋯ Level 4, Case Series, Treatment Study.
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Arch Orthop Trauma Surg · Oct 2024
Efficacy of intra-articular injection of combined platelet-rich-plasma (PRP) and hyaluronic acid (HA) in knee degenerative joint disease: a prospective, randomized, double-blind clinical trial.
Intra-articular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) represent promising options in the conservative treatment of early stages of knee osteoarthritis (OA). Although the combined use of these two compounds seems to have a synergistic effect in pre-clinical studies, few clinical trials compared the association of PRP and HA with PRP and HA alone. The aim of study is to evaluate the efficacy of combined intra-articular injections of PRP and HA in the treatment of mild to moderate knee OA, compared to PRP and HA alone. ⋯ This multicenter, prospective, randomized, double-blind controlled trial revealed that intra-articular injections of PRP + HA, PRP, or HA represent a safe and viable treatment with comparable efficacy in terms of pain relief and functional outcomes in mild to moderate knee OA.
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The Pfannenstiel approach is an often used approach while treating pelvic ring injuries. Especially, symphyseal plating is performed using this approach. The original description is based for performing gynecological transverse caesarean section. ⋯ A transverse fascial incision of the rectus sheaths is usually not performed. Thus, the term Pfannenstiel approach should be replaced by "modified Pfannenstiel approach". Level of evidence V.
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Arch Orthop Trauma Surg · Oct 2024
Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up.
The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet. ⋯ Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.
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Arch Orthop Trauma Surg · Oct 2024
Ilizarov fixator as salvage procedure after frustrating arthrodesis using intramedullary nailing - is there a chance of consolidation?
Arthrodesis of the tibiotalar and subtalar joints is a salvage procedure that has been used successfully for years. Treatment options include internal procedures and external procedures. Retrograde intramedullary nailing is considered a safe procedure with a high degree of stability and comfort. Nevertheless, there are cases in which this internal arthrodesis fails and another procedure must be considered. Ilizarov fixator treatment could be a solution for those patients in whom intramedullary nailing has failed. Even if it means another surgical revision - is it possible to finally achieve consolidation with this method? ⋯ If patients have undergone fusion of the tibiotalar and subtalar joints with a retrograde nail and this fails, it is difficult to achieve complete consolidation in the further course. A further attempt at arthrodesis using an Ilizarov fixator is possible, but the overall results are also poor. This procedure must therefore be seen as a last resort before amputation.