The Outcome of Modified Extended Trochanteric Osteotomy in Revision THA for Vancouver B2/B3 Periprosthetic Fractures of the Femur
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» The indolent microorganisms responsible for shoulder periprosthetic joint infection make diagnosis difficult because they do not have clear clinical signs or reliable serum laboratory markers. » Administering benzoyl peroxide to the skin of the surgical site and intra-articular injections of antibiotics during a surgical procedure have shown potential for preventing periprosthetic joint infection in patients undergoing shoulder arthroplasty. » Measuring the synovial levels of interleukin (IL)-6 and alpha (α)-defensin have demonstrated promise for predicting periprosthetic joint infection in patients undergoing shoulder arthroplasty. » Two-stage revision shoulder arthroplasty has been consistently shown in the literature to effectively eradicate infection and have substantial functional improvement, especially in healthy patients. » One-stage revision shoulder arthroplasty has been shown to have eradication rates comparable with those of 2-stage exchange and has the advantages of being more cost-effective and having expedited treatment time.
Joint arthroplasty
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Objective To analyze the effect of Salter osteotomy and reconstruction of round ligment of femur for the treatment of developmental dysplasia of hip in children.Methods 44 hips in 39 children with developmental dysplasia were treated by Salter osteotomy and reconstruction of round ligment of femur.Results All cases were followed up for 6～24 months.According to JI Shi-jun criteria,35 cases were excellent,6 good,and 3 poor,the excellent and good rate was 93.2%.Conclusions Salter osteotomy and reconstruction of round ligment of femur is effective in treating developmental dysplasia of hip in children.
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人工股関節ステム周囲骨折（Vancouver分類B1）に対する骨接合術はステムが存在するため強固な固定が困難であり，治療に難渋することも多い．今回Cable system& Periprosthetic screwsを用いて治療した症例を経験したので報告する．人工股関節置換術（THA）・人工骨頭置換術（BHP）後のステム周囲骨折に対して本システムを用いて手術を施行した2例である．2例とも女性で受傷時年齢は86歳と84歳，初回手術はTHA 1例，BHP 1例である．骨折型は2例ともVancouver分類B1である．本システムを用いて固定術を行なった．固定性は良好で周術期の合併症も認めなかった．術後3ヶ月までに2例とも骨癒合が得られており，ステムの沈下，ワイヤー・スクリューの緩みや折損も認めていない．本システムは人工関節周囲骨折治療のために開発されたシステムで，LCPとの組み合わせが可能であり，様々な骨折形態に対応している．従って人工関節周囲骨折に対し安定した固定性が期待できる．
Hip Arthroplasty
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Aim: The purpose of this study was to compare the outcomes of locked plating in closed distal femur periprosthetic, and non-periprosthetic fractures. We hypothesized that the outcomes would be superior in the non-periprosthetic distal femur fracture group.
Material and Method: Patients who underwent surgery for distal femur fractures between January 2019 and January 2022 were retrospectively reviewed. Patients aged under 18 years, who had multiple fractures, pathological fractures, follow-up less than 6 months, previous history of revision knee arthroplasty, interprosthetic fractures between hip and knee arthroplasties, fixation performed other than distal locking femoral plate and intra-operative periprosthetic fractures were excluded. Patients’ age, gender, laterality, length of hospital stay, and follow-up duration were obtained from hospital registry notes. Fractures were classified using the AO classification system. At the last follow-up, visual analogue scale (VAS), Tegner activity score, Lysholm knee score, and short form 36 (SF-36) scores were noted.
Results: A total of 30 patients met the inclusion criteria and were included in the study. There were 14 patients in the non-periprosthetic fracture group and 16 patients in the periprosthetic fracture group. The periprosthetic group had significantly lower mean VAS score (p=0.047), Tegner activity score (p=0.015), and Lysholm knee score (p=0.034) than the non-periprosthetic group. The periprosthetic fracture group had significantly inferior quality of life scores compared to non-periprosthetic groups based on SF-36 sub-parameters.
Conclusion: Periprosthetic distal femoral fractures have inferior clinical outcomes and quality of life than non-periprosthetic fractures despite having similar fracture healing rate. Orthopaedic surgeons should be aware of the frailty of the patients caused by prior total knee arthroplasty surgery.
Femur fracture
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The incidences of periprosthetic fracture and periprosthetic joint infection after total hip arthroplasty are expected to increase exponentially over the coming decades. Epidemiologic data suggest that many periprosthetic fractures after THA occur concurrently with a loose femoral implant. Recent studies suggest an approximately 8% incidence of indolent infection in cases of suspected aseptic loosening. The available data, therefore, suggest that periprosthetic fracture and infection may coexist, and this possibility should be considered, particularly in patients with a loose femoral stem and high pretest possibility. Although currently limited, the available literature provides some guidance as how to manage this complex issue.
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Sports medicine
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This chapter presents a case scenario of a 55-year-old man with advanced glenohumeral arthrosis who has failed nonoperative treatment. Infection continues to be a devastating complication following shoulder arthroplasty procedures. Developing effective prevention strategies in shoulder arthroplasty is challenging, due to the low incidence of periprosthetic joint infection (PJI) and the prevalence of infection with low virulent organisms. Establishing the diagnosis of infection with a painful shoulder after arthroplasty is extremely difficult. The current lack of a reliable diagnostic tool for infection may lead to delays in diagnosis, additional operations that could have been avoided, or inappropriate surgery in the presence of an undiagnosed infection. Successful eradication of shoulder PJI lends itself to considerable morbidity including a lengthy treatment course and the need for multiple surgical procedures. All series are retrospective, consist of nonstandardized treatments and the majority lack control groups. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
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