Total joint arthroplasty (TJA) is amongst the most common elective orthopedic surgeries. Since their introduction in 1951 there have been changes not only in prosthesis design and surgical approaches, but also in patient management, anesthesia, drug regimen and robotic arm assistance. These changes led to advancement in patient safety and shorter hospitalization. Today TJA is accessible for a wider age and function range of patients, which has led to an exponential growth in the number of procedures conducted.
Down syndrome is the most common of the non-hereditary genetic syndromes causing mental retardation. In addition to the phenotype characteristics, the syndrome is accompanied by multi-system pathological conditions, both congenital and acquired. These conditions involve the abnormal function of the musculo-skeletal system and affect movement in general and gait component more specifically. The abnormal gait develops from early childhood and continues into adulthood. This review focuses on the characteristics of this syndrome as concerning the damage to the lower extremities and trunk and the typical gait patterns.
Objective: Surgical site infection (SSI) after hip fracture surgery is a well-known complication with serious consequences for both the patient and the medical system. Silver ion treatment is considered an effective antibacterial agent, however, the use of silver dressing (SD) in the primary prevention of SSIs is controversial. The aims of this study were to compare SD with regular dressing (RD) in the prevention of SSI in elderly patients undergoing surgery for hip fractures, and to compare costs. Method: A matched group of 55 patients with hip fractures undergoing surgery with dynamic hip screw, cephalomedullary nail or hemiarthroplasty were randomised to either SD or RD groups. The dressings were applied in the operating theatre, and the patients were followed for one week for clinical signs of infection (discharge, erythema and fever). The RDs were replaced daily. The SDs were not removed for 5–7 days and kept moist. Skin swabs were taken from the wound surface on postoperative day 5–7 for bacterial skin colonisation. Results: The SD (n=31) and RD (n=24) groups were similar in age, sex and comorbidities. Infection signs were seen in two (2/31, 6.4%) of the SD patients compared with 2 (2/24, 8.3%) RD patients (p=1.0). Skin colonisation by bacteria at postoperative day 5–7 was tested in 27 patients: it was higher in the SD group (positive skin swab, 12/19, 63.2%) compared to the RD group (4/8, 50%, p=0.67). The use of SD added ~US$5 (UK ~£3.19) per patient. Conclusion: The use of SD was associated with higher costs than RD, but not superior in preventing SSIs in elderly patients undergoing hemiarthroplasty or fixation of hip fractures. SD was also not effective in reducing bacterial skin colonisation following hip fracture and surgery.
Excision of the proximal femur for tumour with prosthetic reconstruction using a bipolar femoral head places a considerable load on the unreplaced acetabulum. We retrospectively reviewed the changes which occur around the affected hip joint by evaluating the post-operative radiographs of 65 consecutive patients who underwent proximal prosthetic arthroplasty of the femur, and in whom an acetabular component had not been used. There were 37 men and 28 women with a mean age of 57.3 years (17 to 93). Radiological assessment included the extent of degenerative change in the acetabulum, heterotopic ossification, and protrusio acetabuli. The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes in the acetabulum were seen in three patients (4.6%), Brooker grade 1 or 2 heterotopic ossification in 17 (26%) and protrusion of the prosthetic head in nine (13.8%). A total of eight patients (12.3%) needed a revision. Five were revised to the same type of prosthesis and three (4.6%) were converted to a total hip arthroplasty. We conclude that radiological evidence of degenerative change, heterotopic ossification and protrusion occur in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour. The limited extent of these changes and the lack of associated symptoms do not justify the routine arthroplasty of the acetabulum in these patients.
Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon's preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.
The prevalence of overweight and obesity in the western world is growing, and with it there is a growing number of patients with osteoarthritis, a condition that leads to pain and disability. The association between body weight and osteoarthritis is mediated by both mechanical and humeral factors such as growth factors, hormones and mediators of the immune system. This review will present the mechanisms which lead to osteoarthritis, and will discuss available treatments which are suitable for the overweight and obese population, along with promising emerging new treatments.
Shoulder dislocation occurs when the head of the humerus disengages from the glenoid bone. About 95% of shoulder dislocations are traumatic, while the other 5% are not trauma-related in a patient with predisposing factors such as generalized ligamentous laxity. Ninety percent of shoulders dislocate anteriorly from direct force on the arm in the "ABER" position (Abduction- External Rotation). Usually, dislocations are accompanied by injuries to the shoulder that may lead to recurrent anterior shoulder instability and in the long-run, osteoarthritis of the shoulder joint. In the case of traumatic shoulder dislocation in the younger population or competitive sport players, accompanied with bone injury on X-ray's (Bony Bankart or Hill-Sachs), surgical treatment is recommended as soon as possible to avoid recurring dislocation and further joint damage. There are several options to treat recurrent shoulder instability, including soft tissue procedures, bone procedures, and a combination of these procedures. Surgery can be performed by an open or arthroscopic approach.
