Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options

Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction:Results of the SLA-VER noninferiority trial

BACKGROUND Distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare the efficacy of below elbow cast(BEC)and above elbow cast(AEC)in maintaining reduction of manipulated DRFs.METHODS We conducted a prospective,monocentric,randomized,parallel-group,open label,blinded,noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs.Two hundred and eighty patients>18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period.Noninferiority thresholds were defined as a 2 mm difference for radial length(RL),a 3°difference for radial inclination(RI),and volar tilt(VT).The trial is registered at Clinicaltrials.gov(NCT03468023).RESULTS One hundred and forty-three patients were treated with BEC,and 137 were treated with AEC.The mean time of immobilization was 33 d.The mean loss of RL,RI,and VT was 1.59 mm,2.83°,and 4.11°for BEC and 1.63 mm,2.54°,and VT loss were respectively 0.04 mm(95%CI:-0.36-0.44),-0.29°(95%CI:-1.03-0.45),and 0.59°(95%CI:-1.39-2.57),and they were all below the prefixed noninferiority thresholds.The rate of loss of reduction was similar.CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF.Being more comfortable to patients,BEC may be preferable for nonoperative treatment of DRFs.

Oncogenic Osteomalacia Associated with Phosphaturic Mesenchymal Tumor of the Knee: Case Presentation and Review of the Literature

Oncogenic osteomalacia (OOM) is an uncommon metabolic and bone disease caused by fibroblast growth factor 23 (FGF23), a phosphaturic factor produced by phosphaturic mesenchymal tumors (mixed connective tissue variant, PMTMCTV) characterized by phosphate leakage from kidneys and subsequent hypophosphatemia. In this paper, we present the case of a patient, 42-year-old woman affected by left side limp and pain involving lumbar spine, pelvis and hip joints, referred to the Rheumatology Department of our Hospital for the treatment of a suspected sero-negative spondilo-arthritis. During hospitalization patient began an immuno-suppressive therapy with TNF-alpha inhibitors associated with Pamidornate, Indometacin, Esomeprazole and vitamin D3. Nevertheless pain did not decrease and a new examination found a worst hypophosphatemia (1 mg/dl) with normal Ca and PTH’s plasma values. During the same check-up a painful bulge on the anterior part of the right knee was observed and the Magnetic Resonance Imaging scan revealed an ovular solid lesion in the soft tissue closed to the upper part of the patella. Histological analysis identified the lesion as a PMTMCTV. After surgical removal patient got complete recovery. We will discuss about diagnostic evaluation, differential diagnosis and treatment.

Minimally Invasive Surgery of the Forefoot: Current Concept Review

A minimally invasive surgical technique (MIS) is any procedure that could be less invasive than open surgery used for the same purpose. Though MIS often involves small incisions or percutaneous approaches, its main goal is to achieve good therapeutic results with the least damage to functional anatomic structures. Minimal invasiveness in orthopaedic forefoot surgery, including first ray and lesser toes, with its growth over the last two decade, showed many advantages and good outcomes with the aim to obtain fewer complications due to a contained approach, shorter surgical time and exposure, lesser post-operative risk of infection, lesser pain, hospitalization and post-operative recovery time, compared with traditional open approaches. This appears particularly true for what concerns hallux valgus surgical correction. MIS techniques have proven in the literature to be reliable, providing today comparable results with traditional open approaches.