bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravitreal Ranibizumab in the Treatment of Choroidal Neovascularization Associated with Idiopathic Central Serous Chorioretinopathy
Authors: Konstantinidis Lazaros , Mantel Irmela , Zografos Leonidas , Ambresin Aude
Published: January 2018

Purpose

We evaluate the functional and anatomic outcome after intravitreal ranibizumab treatment in patients with choroidal neovascularization (CNV) related to chronic central serous chorioretinopathy (CSC).

Methods

This is a small case series of 5 eyes with CNV associated with chronic CSC treated with intravitreal injection of 0.5 mg ranibizumab in the Jules Gonin University Eye Hospital from July 2007 to July 2009. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus examination, and optical coherence tomography (OCT). Fluorescein and indocyanine green angiography (ICG) were performed at baseline and repeated at least every 6 months.

Results

We studied 5 eyes of 4 patients with a mean age of 66 years. Mean follow-up was 21 months (SD 1.9). The mean number of intravitreal injections administered for each patient was 10(SD4.6). The mean initial BCVA was 0.23 (decimal equivalent) (logMAR 0.64, SD 0.13). At the last follow-up, mean BCVA was 0.44 decimal equivalent (logMAR 0.36, SD 0.31). Mean central macular thickness (CMT) measured with OCT was 330 μm (SD 43) at baseline and decreased at the final follow-up to 243 μm (SD 44). Persistent intraretinal or subretinal fluid on OCT and/or multifocal areas of increased choroidal permeability on ICG angiographies were present in all patients at the last follow-up visit.

Conclusions

Intravitreal ranibizumab appeared to be an effective treatment of CNV related to chronic CSC. However, residual intraretinal or subretinal fluid and increased choroidal permeability persisted. Prospective controlled studies are warranted to evaluate the long-term safety and efficacy of intravitreal ranibizumab.
Pseudophakic Eye Globe Disruption
Authors: Motolese Llaria , Motolese Paolo Alfonso , Frezzotti Paolo , Fruschelli Mario , Motolese Eduardo
Published: January 2018

Purpose

Scleral rupture due to bulb bursting can result from a heavy contusion. Owing to refined surgical techniques and the use of antibiotics and cortisone-based medication, more conservative concepts have followed. In major ruptures, the results were almost always very poor, with atrophy or subatrophy of the eyes.

Methods

A 63-year-old man with major left ocular trauma and intraocular lens dislocation in the subconjunctival area was referred to the authors for clinical and surgical evaluation.

Results

Surgery was performed 3 weeks after the trauma to allow for improvement in the patient's condition. The reabsorption of a palpebral-frontal hematoma, which made bulb exploration almost impossible, was fundamental in order to proceed. After 1 year, the best-corrected visual acuity was 0.9. In fact, great improvements in surgical techniques in recent years have allowed us to consider the problem of major rupture in a new way, both technically and from an organizational point of view.

Conclusions

In terms of organization, the concept of urgent surgical procedures must be reevaluated, because besides traumatic damage, incomplete surgical measures may result. This makes all treatment useless, in both barely equipped and highly specialized centers.
Experience with Intravitreal Bevacizumab as a Preoperative Adjunct in 23-G Vitrectomy for Advanced Proliferative Diabetic Retinopathy
Authors: Mota Sergio E. Hernández-Da , Nuñez-Solorio Silvia M.
Published: January 2018

Purpose

To evaluate the safety and efficacy of intravitreal injection of bevacizumab before vitrectomy in advanced proliferative diabetic retinopathy.

Methods

A randomized clinical trial was performed on 40 eyes of 40 patients. Inclusion criteria were advanced proliferative diabetic retinopathy with fractional retinal detachment and HbA1c <7%. Patients were randomly assigned into 2 groups. Patients in one group had an intravitreal injection (1.25 mg) of bevacizumab 48 hours before 23-G pars plana vitrectomy surgery was performed, whereas the other group did not. Best-corrected visual acuity, intraocular pressure, and fundus photographs were taken prior to surgery 1 week and 3 and 6 months postoperatively.

Results

Effective vitrectomy time was 8.05 minutes in the bevacizumab group vs 16.8 minutes in the non-bevacizumab group. Statistically significant differences were observed in visual acuity at 1 week and 3 and 6 months follow-up between the 2 groups (p<0.05 for each visit). Also, there was less bleeding intraoperatively in the bevacizumab group. Mean final visual acuity in the bevacizumab group was 0.82 logMAR and 2.01 logMAR in the non-bevacizumab group.

Conclusions

Adjuvant intravitreal injection of bevacizumab prior to vitrectomy in diabetic retinopathy with fractional retinal detachment significantly eases the procedure, diminishing intraoperative complications, and leads to a better visual outcome.
Ultrasound Biomicroscopy Imaging of Sclerotomy in Children with Cataract Undergoing 25-Gauge Sutureless Pars Plana Anterior Vitrectomy
Authors: You Caiyun , Wu Xiaoming , Ying Liang , Xie Lixin
Published: January 2018

Purpose

To investigate the healing course and features of sclerotomy in children with cataract undergoing 25-gauge sutureless pars plana anterior vitrectomy by ultrasound biomicroscopy (UBM) imaging.

Methods

25-Gauge sutureless pars plana anterior vitrectomy was performed in 15 eyes for congenital or developmental cataract surgery (mean age 6.9 years, range 5–10 years). Time of anterior vitrectomy, intraoperative and postoperative clinical observations, postoperative complications, and UBM imaging of sclerotomy sites were evaluated.

Results

The mean time of anterior vitrectomy was 40.9 seconds (range 26–53 seconds). A stable intraocular pressure and a slight disturbance on vitreous were found intraoperatively Postoperative inflammation in anterior chamber was mild with fast postoperative recovery. Fluid leakage, vitreous incarceration, hypotony or any other complications were not noted in any of the eyes. UBM imaging showed that the sclerotomy was detected as a gape through the sclera on day 3 and decreased in size obviously on day 7 after surgery. The internal opening of the gape was cured on postoperative week 2 with inability to detect its internal lip. The scleral wounds in 11 (73.3%) of the eyes were undetectable at week 3 by UBM imaging and all sclerotomy sites were cured at week 4 postoperatively.

Conclusions

UBM imaging on pediatric cataract eyes showed that healing of a 25-gauge sclerotomy was rapid and no leakage or vitreous incarceration from the scleral wound was found.
Efficacy and Safety of Short-Duration Topical Treatment with Azithromycin Oil-Based Eyedrops in an Experimental Model of Corneal Refractive Surgery
Authors: Merayo-Lloves Jesús , Blanco-Mezquita Tomás , Ibares-Frías Lucía , Cantalapiedra-Rodríguez Roberto , álvarez-Barcia Ángel
Published: January 2018

Purpose

To assess the tolerance and side effects of azithromycin eyedrops at the ocular surface after corneal refractive surgery in an experimental animal model.

Methods

The effect of azithromycin eyedrops was evaluated in hen corneas that underwent laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) surgery in 1 eye, using the fellow eye (not manipulated) as a control. Animals were treated bid 3 days prior to surgery and 3 days after surgery with T1225 1.5% azithromycin eyedrops or saline eyedrops (balanced salt solution), or were left untreated as a control. Clinical course and cell biology (apoptosis, proliferation, and differentiation) measurements were assessed.

Results

Infections were present in the following proportions of corneas operated on by LASIK: 0% treated with azithromycin, 60% treated with BSS, and 30% untreated. No corneal abscess or keratitis were present in any PRK or unmanipulated corneas. Conjunctival edema and redness were less prevalent in LASIK-operated eyes treated with azithromycin than in BSS-treated or untreated eyes and were not observed in any PRK or unmanipulated corneas. In PRK-operated eyes treated with azithromycin, a decrease was observed in the apoptosis and an increase in the stromal proliferation. There were no differences in these parameters for LASIK and unmanipulated eyes.

Conclusions

Topical administration of T1225 oil-based azithromycin eyedrops was well tolerated in both unmanipulated hen corneas and those treated with corneal refractive surgery (PRK and LASIK). T1225 demonstrated a potent antibiotic effect after LASIK treatment.
The Frequency of Pseudoexfoliation Syndrome in the Middle Black Sea Region of Turkey
Authors: Cumurcu Tongabay , Kilic Rasit , Yologlu Saim
Published: January 2018

Purpose

To assess the frequency of Pseudoexfoliation syndrome (PEX) and evaluate its association with specific ocular diseases in patients attending the Department of Ophthalmology at Gaziosmanpasa University Hospital.

Methods

A prospective study was conducted at the Gaziosmanpasa University Hospital between December 2007 and December 2008. A total of 831 subjects aged 45 or above attending the general ophthalmic clinics were recruited for this study. Each patient underwent complete ophthalmic assessment, including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, gonioscopy and fundus examination.

Results

Of the 831 subjects, 12.2% had PEX. Pseudoexfoliation was bilateral in 74.2% of cases, significantly associated with cataract, glaucoma, age-related macular degeneration (AMD), and phacodenesis. Of the patients with PEX, 43.6% had cataract, 6.9% had glaucoma, 7.9% had AMD, and 0.9% had phacodenesis. In addition, 9.8% had cataract + glaucoma, 13.7% had cataract + phacodenesis, and 17.8% had all of them. The prevalence of PEX had a tendency to increase with age but had no sex predilection.

Conclusions

The study findings enhance our knowledge of PEX in Anatolia, particularly in the Middle Black Sea region.
Post-thrombotic syndrome after total hip arthroplasty
Authors: Zenios M. , George V. , Helm R.H.
Published: January 2018

The prevalence of post-thrombotic syndrome was assessed in 46 patients at least six years following total hip arthroplasty. Patients were examined clinically and sonographically. Post-thrombotic syndrome was diagnosed on the basis of both sonographic and clinical examination. The incidence of post-thrombotic syndrome in our study is 26.1%. Our study suggests that post-thrombotic syndrome is a common and clinically significant problem following total hip arthroplasty. Anticoagulant therapy in the early postoperative period has not been effective in preventing post-thrombotic syndrome.
Total hip arthroplasty in skeletal dysplasia
Authors: Umarji S.I.M. , Lee M.B. , Gargan M.F. , Portinaro N.M.A. , Learmonth I.D.
Published: January 2018

This study presents the results of 38 hip prostheses in 24 people of short stature (under 152 cm). A retrospective clinical and radiological study recording the diagnosis, age at reconstruction, height, weight, type of prostheses, length of follow-up, radiological appearances and patient satisfaction was performed. Harris hip scores were used to assess activities of daily living (1). All patients were under 152cm and their diagnoses included achondroplasia, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, developmental dysplasia of the hip and juvenile chronic arthritis. The mean height of these patients was 135 cm (range: 109cm to 150cm). The mean age was 38 years (range: 19 to 75 years) with mean follow-up 67 months (range: 12 to 406 months). Only one patient, who is now aged 69 years (though 65 years at revision surgery), has required revision surgery to date. The results were excellent for 33 hips (Harris hip score between 80–100), good in three (Harris hip score between 70–80), satisfactory in one (score 60–70) and poor for one (Harris hip score <50). The mean Harris hip score to date is 89. Hip replacement surgery is difficult in this challenging group of patients but can nonetheless yield gratifying results in over 90% of cases.
Isolated Hip Infection by Paracoccidioides Brasiliensis: A Case Report
Authors: Picado C.H.F. , Garcia F.L. , Barbieri C.H.
Published: January 2018

Paracoccidioidomycosis is a fungal infection that presents a diagnostic challenge even in endemic areas, due mainly to the multiplicity of clinical manifestations and organs involved. We describe a case of the disease that only affected the hip, a very unusual situation.
Endoprosthetic replacement for malignant bone tumours of the proximal femur
Authors: Rosa M.A. , Maccauro G. , Muratori F. , Rodà M.G.
Published: January 2018

Limb salvage procedures are considered the gold standard in the treatment of bone tumours. The use of modular prostheses is one of the options for reconstruction after bone resection in primary tumours and in very restricted cases also in bone metastases. The authors report the results of 27 consecutive cases of proximal femur bone resections and reconstructions with modular prostheses, using the Mutars system. Soft tissue reconstruction and anchorage to the implant was performed using the Trevira tube. The system stem used showed good mechanical resistance, and implant removal was required for infection in only two cases. Functional results were related to the degree of bone resection and muscular sacrifice.
Use of re-transfusion versus vacuum drains in primary total hip replacement
Authors: Gardner A. , Datta A. , Bell K.
Published: January 2018

Whilst the use of re-transfusion drains in primary knee arthroplasty has gained acceptance in reducing the requirement for donor blood products postoperatively, their use in total hip arthroplasty remains uncertain. Using two groups of 32 patients, a comparison was made between re-transfusion drains and vacuum drains in primary total hip arthroplasty in one centre and the requirement for postoperative donor blood. No statistically significant difference was found between the groups in terms of blood loss (p=0.51) or requirements for postoperative blood transfusion (p=0.12). The use of re-transfusion drains in primary total hip arthroplasty did not alter the rate of postoperative blood transfusion.
Hip replacement of the ovine hip with a zero dislocation rate
Authors: Blom A.W. , Hubble M. , Eldridge J. , Learmonth I.D. , Goodship A.E.
Published: January 2018

Ovine and caprine animals are frequently used as in vivo models for both total hip replacement and hemiarthroplasty. Historically the complication rate, particularly the dislocation rate, has been high. In studies involving animals it is imperative to keep complications to a minimum, both to reduce the distress of the individual animals, and also to keep the number of animals used in each study to the absolute minimum required.

We describe an approach that has had a dislocation rate of zero out of 69 hips (mean follow-up 11 months). The authors recommend this approach in ovine and caprine studies of the hip joint.
Distal Femoral Cortical Hypertrophy: Predisposing Factors and Their Effect on Clinical Outcome
Authors: Katsimihas M. , Katsimihas G. , Lee M.B. , Learmonth I.D.
Published: January 2018

The clinical and radiographic features of 109 hybrid total hip replacements performed between 1986 and 1992 in 96 consecutive patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases.

The overall prevalence of distal femoral cortical hypertrophy (DCH) was 43.1%. Male sex, underlying diagnosis of avascular necrosis and Charnley grade A were among the factors that predisposed to the development of DCH. The prevalence of stem radiolucencies was lower in the group of patients who developed DCH compared with those without hypertrophy.

The Harris Hip Score ranged between 5 and 54 preoperatively and the average HHS was more than 80 postoperatively. No association was found between DCH and thigh pain.
Previous Medical Problems in 326 Consecutive Hip Fracture Patients
Authors: Escobar L. , Escobar R. , Cordero-Ampuero J.
Published: January 2018

Pre-existing medical problems of elderly patients with hip fracture are seldom considered in orthopaedic literature, although they are indisputably the most important determinants for mortality, morbidity and final outcome. It is the purpose of this study to determine these problems in our hip fracture patients. Previous medical disorders and treatments, age, sex and type of fracture were prospectively recorded from all patients over 65 years old, diagnosed with hip fracture in a tertiary university general hospital during 2004. There were 326 patients who fractured their hip (81.04 hip fractures/100,000 people/year) (83.6±7.3 years old) (85.3% female). The patients' existing medical conditions included hypertension (53% of patients), diabetes (19%), dementia (18%), cerebrovascular disease (11%), cataracts and/or blindness (10%), cardiac arrhythmia (9%), chronic obstructive pulmonary disease (9%), heart failure (8%), ischaemic heart disease (7%), psychiatric disorders other than dementia (7%), peptic ulcer (7%), and Parkinson's disease (5%); only 7% had no known significant medical problem beyond their fracture. Cardiovascular and neurological disorders, the most frequent, were also the most dangerous as potential sources for complications and difficulties during anaesthesia, surgery, immediate postoperative period and rehabilitation. Diabetes, the second most frequent diagnosis, complicated any other existing condition.
Thirty-two Millimetre Heads and Accelerated Polyethylene Wear in Total Hip Arthroplasty
Authors: Blom A.W. , Madhavan P. , Lee M. , Learmonth I.D.
Published: January 2018

In total hip arthroplasty 32 mm heads are often used as the greater diameter is thought to contribute to improved stability. However, greater head diameter can also lead to greater volumetric wear.

We compared polyethylene wear between patients with 32 mm heads and those with smaller heads. All patients who had Harris Galante1 metal-backed, uncemented cups inserted between 1986 and 1996 at our institute were annually reviewed clinically and radiographically.

Accelerated polyethylene wear was noted between the fifth and seventh postoperative year in 17 out of 165 total hip replacements with 32 mm heads, but only in 21 out of 961 total hip arthroplasties with smaller femoral heads. In all 17 THRs, accelerated wear was also associated with thin polyethylene (<6 mm).

This paper highlights a potentially serious problem. When 32 mm metal heads are used with uncemented cups and polyethylene liners, there is a risk of accelerated acetabular wear in patients with thin polyethylene.
Case report: Overnight Hospital Stay for Minimally Invasive Bilateral Total hip Arthroplasty
Authors: Findlay I.A. , Chettiar K.K. , Stenhouse J.L. , Slater A.J. , Apthrop H.D.
Published: January 2018

Bilateral total hip arthroplasty was performed on a 58-year-old man. He was successfully discharged home from hospital the following morning, 23 hours post surgery. A direct anterior, minimally invasive approach was used which avoided detachment of hip musculature. Preoperative assessment was carried out, with early multidisciplinary team input. Modified anaesthetic techniques with an ambulatory pain pump were employed. Follow-up in the community was carried out by an outreach team. All these factors were important in a successful early supported discharge. We believe this to be the first such case reported.
Ochronotic Arthropathy with Severe Articular Involvement Necessitates Total Joint Replacement
Authors: Gasparini G. , Cerciello S. , Vasso M. , Cillo M.
Published: January 2018

The aim of this paper is to describe the pathological and clinical features of alkaptonuria (AKU). AKU clinical presentation is identified as ochronosis, the dark pigmentation of skin and cartilage that is caused by progressive accumulation of homogentisic acid (HGA) in connective tissues. We also discuss surgical considerations about joint replacement, which represents the only treatment in the case of severe articular degeneration.

We report the case of a middle-aged female with both hip and knees affected. She underwent bilateral hip replacement and right knee arthroplasty. Preoperatively, the patient was examined clinically. Harris Hip Score (HHS) and Hospital for Special Surgery score (HSS) were completed for both hips, and for the right knee. Radiographs were made of both hips and the knee, in different projections.

HHS for the left and right sides at the latest follow-up (11 and 9 years after surgery respectively) were 98 and 95. HSS 3.5 years after surgery was 97.

Alkaptonuria is a rare inherited pathology caused by deficiency of the enzyme homogentisic acid oxidase (HGAO). Skeletal involvement is frequent and causes severe cartilage damage. HGA levels in blood and urine and articular symptoms make the diagnosis certain. Therapy is still debated: diet offers good results in young people while high doses of C vitamin seem to reduce the amount of deposits. Articular localizations usually lead to joint replacement. In this case functional and radiographic results are excellent even at long follow-up.
MicroHip: A Minimally Invasive Procedure for Total Hip Replacement Surgery: A modified Smith-Petersen approach
Authors: Michel M.C. , Witschger P.
Published: January 2018

In this article we present the surgical technique of our anterior minimally invasive approach to the hip joint. This is aligned along an interneural plane and makes the approach truly minimally invasive. This technique is performed in a lateral decubitus position on a normal operating table; there is no need for a specific orthopaedic or fracture table. As leg traction is not necessary, this enables the approach to be used routinely. Most of the instruments used for this procedure are standard instruments; only the acetabular reamers and positioners are angulated and specifically designed. The angled instruments (MI – minimally invasive) are especially useful when performing hip replacement in obese patients.

An excellent view of both the acetabulum and the proximal femur can be obtained through an incision of only 6–8cm, using this MI approach. The approach follows the interval between the tensor fascia lata muscle and the rectus muscle using a section of the anterior iliofemoral approach described by Smith-Petersen. No tendon or muscle is cut or detached. The joint capsule is split and left in place. The hip joint is not dislocated and we perform the osteotomy of the femoral neck in situ. To date we have performed over 500 MicroHip™ operations. We have not observed any nerve lesions or fractures of the trochanter. Our experience to date shows that the method we have developed allows us to operate reliably on virtually any patient. Preliminary results also show that important factors like length of stay, pain, blood loss and return to work can be reduced significantly. The MicroHip™ technique is being used by more and more different clinics all over the world and can be applied with success after suitable training.
Randomised Controlled Trial Comparing two Methods of Acetabular Cup Positioning during Total Hip Arthroplasty
Authors: Vendittoli P.-A. , Ganapathi M. , Duval N. , Lavoie P. , Roy A. , Lavigne M.
Published: January 2018

Background

Acetabular cup positioning is an important technical aspect in total hip arthroplasty. Most surgeons estimate cup abduction angle during surgery with the insertion rod position according to the patient's body anatomical landmarks or other reference points in the operating room. High acetabular component abduction angle is associated with an increased risk of dislocation, premature polyethylene wear and osteolysis.

Method

To evaluate the potential benefits of a new technique for vertical acetabular cup positioning, 100 acetabular cups were randomised to be inserted with or without an inclinometer. Abduction angles were measured on postoperative radiographs by 2 evaluators blind to the treatment group.

Results

Of the cups, 57% (27/47) were positioned within the desirable abduction angle range of 40°–49° with the inclinometer, compared with 50% (27/53) by visuospatial perception (p=0.454). The proportion of cups positioned outside a safe angle range of 30°–55° was low in both groups: 6% (3/47) for the inclinometer group versus 4% (2/53) for the visuospatial perception group (p=0.536).

Conclusion

The use of an inclinometer did not significantly improve the acetabular cup abduction angle obtained by our group of surgeons when compared with visuospatial perception. Newer techniques such as navigation may be useful in further optimising cup positioning and reducing the outliers.
Slipped Capital Femoral Epiphysis
Authors: Mitchell S.R. , Tennent T.D. , Brown R.R. , Monsell F.P.
Published: January 2018

Slipped capital femoral epiphysis is a condition likely to be encountered by all practising orthopaedic surgeons. A sound knowledge of the risk factors, presentation, investigation and management is essential to prevent the potentially significant consequences of missing the diagnosis. We present an overview of the condition, along with a review of the relevant literature to date.
The Trident Constrained Acetabular (Bipolar) Component for Recurrent Dislocation. New Mode of Liner Failure
Authors: Harvie P. , Kemp M. , Whitwell D.
Published: January 2018

Recurrent dislocation after reconstructive hip surgery remains a challenging problem to treat. Constrained acetabular components can provide an excellent solution, in selected patients. Failure of constrained components may still occur despite excellent component implantation and occurs at the liner-shell and shell-bone interfaces usually as a result of trauma or aseptic loosening. We describe the failure of a Trident bipolar acetabular component at its bipolar/insert interface, a previously unreported mode of failure.
Anomalies of the Natural Correction of Dysplasia of the Hip and Treatment Proposals
Authors: Terver S. , Hery J.Y. , Faher M. , Picquel X. , Castillo O.
Published: January 2018

The spontaneous correction of hip dysplasia occurs at every level of growth of the lower limb and it may be inadequate at any of these levels. Every abnormality of correction may induce different troubles at any level of the lower limb. A complete clinical evaluation, X-ray with different special views and CT examination is mandatory. Every deformation in any of the three spatial planes must be detected for a good understanding of the defect. The authors describe the X-ray techniques necessary for a complete evaluation of the patient and propose a CT protocol to precisely calculate the different angles of torsion of the lower limb. The possibilities of surgical treatment at different levels of the lower limb (acetabular, femoral, tibial and ankle or foot level) in DDH are pointed out to address directly the proper procedure at the correct level of the pathology.
Surgical Treatment of Late Congenital Dislocation of the Hip (after 4 Years of Age)
Authors: Cigala F. , Lotito F.M. , Sadile F.
Published: January 2018

The goal of the surgical treatment in previously untreated juvenile hip displacement is to achieve a stable and concentric reduction of the femoral head with the best range of motion and without severe complications related to avascular necrosis (AVN) and stiffness of hip joint.

In this paper the authors describe their approach in the treatment of the patients affected by neglected high dislocation of the hip joint observed after 4 years of age, when all of them had been ambulant for several years. They point out, on the basis of their experience, the importance of avoiding damage to the vessel supply of the dislocated femoral head, respecting the soft tissue and the use of different surgical techniques to perform acetabuloplasty in relation to skeletal age, in order to obtain good hip stability and congruency good range of motion for 20 years at least, and to prepare the hip joint for further surgical intervention in the best way possible when inevitable osteoarthritis occurs.
Cementless Total Hip Arthroplasty Using Custom Stem and Reinforcement Ring in Hip Osteoarthritis following Developmental Dysplasia
Authors: Flecher X. , Parratte S. , Aubaniac J.M. , Argenson J.N.
Published: January 2018

The anatomical deformities encountered in osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) may lead to some technical difficulties when performing total hip arthroplasty The aim of this study is to present our experience in anatomical analysis of OA following DDH and its treatment using cementless THA with a customized stem and a reinforcement ring.

In anatomic X-rays and CT-scan studies of 83 hips with osteoarthritis following DDH, a great individual variability was shown despite the subluxation class considered with a reduced mediolateral and anteroposterior dimensions of the intramedullary femoral canal in all groups. Greater anteversion (ranging from 2° to 80°) in all the DDH groups and a femoral neck shaft angle increased only for femora of class II were found. Another group of 116 luxations of the hip was clinically followed. Clinical outcome was found to be not correlated with the severity of luxation. The problems encountered to restore the center of rotation in THA for DDH correlated well with the severity of dislocation. The postoperative limp was correlated with a vertical position of the acetabular component of more than 35 mm from the interteardrop line. Taking into consideration hip revision for stem or acetabular replacement, the cumulative survival rate was 94.7% ± 2.7% at 12 years.

Cementless custom stem is certainly a step forward in the future of hip arthroplasty in a young and active population with DDH to probably include in a preoperative and intraoperative computer assisted surgery
Reactive Synovitis following hip Resurfacing: A Case Presentation
Authors: Peacock A. , Say J. , Lawrence T.
Published: January 2018

We report a case of metal-on-metal hip resurfacing complicated by a reactive synovitis and a large effusion resulting in dislocation, peripheral oedema and groin discomfort. Histological analysis of the retrieved specimens revealed an intense lymphocytosis. Conversion to a traditional hip replacement resulted in resolution of the symptoms.
Early Discharge after Hip Arthroplasty with Home Support: Experience at a uk District General Hospital
Authors: Thomas G. , Faisal M. , Young S. , Asson R. , Ritson M. , Bawale R.
Published: January 2018

One hundred and thirty-eight consecutive patients undergoing hip arthroplasty and accelerated discharge at our institution over 6 months were reviewed. Our protocol included transfer to a dedicated home support team. No minimal incision techniques or special anaesthetic / analgesic techniques were used. 66% of patients having primary joint replacements went home by the third post operative day and 91% by the fourth day. Re-admission rates were under 1% whilst under the care of the home support team. Patient satisfaction was high. 94% said they would use the service again. This protocol has saved over 1500 bed days per year whilst maintaining standards of care.
A Displaced Acetabular Component Causing Femoral Neck Notching following Hip Resurfacing
Authors: Kabir C. , Sandiford N. , Muirhead-Allwood S.K. , Nuthall T.
Published: January 2018

We describe the case of a patient who developed a notch on the femoral neck following a hip resurfacing operation as a result of a displaced acetabular component. The acetabular cup displaced in the coronal plane and impinged on the femoral neck leading to a large notch in the inferior femoral neck.
Leg Length and Offset following hip Resurfacing and Hip Replacement
Authors: Ahmad Riaz , Gillespie Gordon , Annamalai Suresh , Barakat Mohannad J. , Ahmed Shahbaz M. Y. , Smith Lindsay K. , Spencer Robert. F.
Published: January 2018

We measured and compared critical parameters on antero-posterior radiographs from 28 patients who had undergone hybrid hip replacement (CPS/EPF), with 28 patients who had undergone cemented hip resurfacing (Cormet). All operations were performed by a single surgeon or under his supervision. We measured the femoral offset, acetabular offset, cup height and leg length on pre and post operative radiographs. The mean difference in femoral offset post-operatively was 3.52 mm (95% CI: -1.10 to 8.14 mm) in the hybrid group and -1.30mm (95%CI: -2.88 to 0.29 mm) in the resurfacing group. Using the independent sample t test (two-tailed), the difference between these means was significant, test statistic t 2.025, p<0.05. This suggests that resurfacing restored the femoral offset more accurately than hybrid hip replacement. The mean difference in leg length post-operatively was 11.91 mm (95% CI: 8.21 to 15.62 mm) in the hybrid group and 4.87 mm (95% CI: 3.32 to 6.42 mm) in the resurfacing group. Using the independent sample t test (two-tailed), the difference between the means was significant, test statistic t 3.597, p<0.001. This suggests that resurfacing produced less change in leg length post-operatively than hybrid hip replacement. We found no statistically significant difference in ideal pre and post operative centre of rotation in the two groups. Proximal femoral anatomy was restored during hip resurfacing by resecting bone of a thickness determined by corresponding preoperative templating and implant thickness rather than relying on placement of the cutting ring at the head-neck junction. No femoral neck fractures occurred in the resurfacing group.
Minimally Invasive Management of Unstable Proximal Femoral Extracapsular Fractures using Reverse LISS Femoral Locking Plates
Authors: Ozkaya Ufuk , Bilgili Fuat , Kilic Ayhan , Parmaksizoglu Atilla Sancar , Kabukcuoglu Yavuz
Published: January 2018

The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. The mean age was 71 years (range; 65–79). The mean follow up was 24 months (range; 15–32). The main outcome measures were union, union time, requirement for secondary procedures, development of deep infection, pain, and functional impairment. Nonunion was observed in one patient. The average Harris hip score at the last assessment was 73 points (range 58–85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.
Acid Etching does not Improve CoCrMo Implant Osseointegration in a Canine Implant Model
Authors: Jakobsen Stig S. , Baas Jorgen , Jakobsen Thomas , Soballe Kjeld
Published: January 2018

Induction of bone ingrowth by topographical changes to implant surfaces is an attractive concept. Topographical modifications achieved by acid etching are potentially applicable to complex 3D surfaces.

Using clinically relevant implant models, we explored the effect of wet etching porous bead-coated CoCrMo. The study was designed as two paired animal experiments with 10 dogs. Each dog received four implants; one in each medial femoral condyle (loaded 0.75-mm-gap model) and one in each proximal tibia (press-fit). The implants were observed for 6 weeks and were evaluated by biomechanical pushout tests and histomorphometry. We found that wet etching porous bead-coated CoCrMo implants failed to improve implant performance. Moreover, a tendency towards increased fibrous tissue formation, decreased new bone formation, and decreased mechanical fixation was observed. Surface topography on implants is able to stimulate bone-forming cells, but the clinical performance of an implant surface perhaps relies more on 3D geometrical structure and biocompatibility. Caution should be exercised regarding the results of wet etching of porous bead-coated CoCrMo and there is a need for more preclinical trials.
Unilateral vs. bilateral total hip arthroplasty – the influence of medial femoral head offset and effects on strength and aerobic endurance capacity
Authors: Husby Vigdis S. , Bjørgen Siri , Hoff Jan , Helgerud Jan , Benum Pål , Husby Otto S.
Published: January 2018

The purpose of the present study was to determine whether unilaterally operated total hip arthroplasty (THA) patients were superior to bilaterally operated THA patients with respect to aerobic endurance capacity, muscle strength and gait patterns 3–5 years after surgery, and to what extent medial femoral head offset (FO) influenced hip abductor strength. 10 unilaterally operated THA patients with normal FO (UNO), 10 bilaterally operated THA patients with normal FO (BNO) and 10 bilaterally operated THA patients with abnormal offset (BDO) participated in the study. Improved muscle strength in the healthy leg of the UNO did not result in differences compared to the BNO and the BDO in work efficiency, gait patterns or maximal oxygen consumption (VO2max) A reduced FO in the BDO did not result in lower hip abduction strength compared to the BNO. However, a correlation between reduced FO and low abduction strength was found in the BDO (r=0.866, p=0.001). Future focus should be on the quality of rehabilitation.
Retroperitoneal Abscess following Infected Bipolar Hemiarthroplasty Diagnosed by Metallosis: A Case Report
Authors: Fujishiro Takaaki , Hayashi Shinya , Kanzaki Noriyuki , Oka Shinya , Kurosaka Masahiro , Nishiyama Takayuki
Published: January 2018

We present a patient with the rare association of a retroperitoneal abscess and infected bipolar hemiarthroplasty diagnosed by metallosis in the abscess preoperatively. T1 and T2 weighted magnetic resonance images revealed a very low signal area, suggesting the presence of particulate metal in the abscess. Critical interpretation of imaging may be useful in such cases.
Dialysis Prescription in Elderly Hemodialysis Patients
Authors: Mandolfo S. , Bucci R. , Ravani P. , Imbasciati E.
Published: January 2018

A growing number of elderly patients have started dialytic treatment in recent years. In spite of this fact, there is very little literature on dialysis prescription in these patients. In this paper, the authors examine the single variables of Kt/V index and report on their own experience when prescribing the dialytic dose in elderly patients. Regarding dialyzer clearance (Kd), it is known that in order to obtain a high Kd we need an adequate vascular access. In our experience, with a radiocephalic fistula elderly patients showed less (but not significantly so) Qac than younger patients (738 ± 350 ml/min versus 892 ± 491 ml/min). We can therefore consider this type of fistula as the first vascular access in elderly patients also. As far as Kr is concerned, its rate of decline (0.4±0.4 ml/min/month) in these patients, excluding those with diabetes or a history of heart failure, is not different from that of younger patients. Treatment time remains a crucial point for adequacy. In order to avoid hypotensive episodes, especially in the elderly, we suggest T = 180 minutes minimum, and ultrafiltration rates should not exceed 0.6–0.8 kg/h. As regards V, it can be stated that these patients have a reduced lean body mass and total body water, and could therefore require smaller dialysis doses. However, we think that the target of Kt/V in malnourished elderly patients requires further study. What our data on Kt/V delivered to a large group of patients shows is that the elderly received the same adequate dialytic dose (Kt/V > 1.3) as that of younger patients.
Bovine and PTFE Vascular Graft Results in Hemodialysis Patients
Authors: Sert Ş. , Demiroǧullari B. , Anadol A. Ziya , Güvence N. , Dalgiç A.
Published: January 2018

Purpose

There are many reports of patency periods, failure rates, thrombosis and infection attacks connected with vascular grafts. In this article, the results of polytetrafluoroethylene (PTFE) and Bovine grafts were compared in a forty-four month period.

Methods

61 vascular grafts (29 PTFE, 32 bovine) were placed in 49 patients. The grafts were compared in different ways, such as survival, complication rates and placement area using life survey analysis.

Results

Mean survival time was 17 mo (SE ± 2.8) for PTFE grafts and 11 mo (SE ± 1.1) for bovine grafts. A failure rate of 34% due only to graft complications were found in PTFE and 25% in bovine grafts. All graft complications were seen in the first year. Comparison of the cumulative survival rates of the groups were found to be insignificant during the study period and the first year (p>0.05). Regardless of the type, there was no significant difference between the grafts placed in the forearm and the grafts in the thigh (p>0.05).

Conclusions

There is no survival difference between PTFE and bovine grafts. First year of the grafts is important for developing complications.
Spontaneous Re-Canalization of Thrombosed Polytetrafluoroethylene (PTFE) Grafts
Authors: Agraharkar M. , Martinez M.A.
Published: January 2018

Fibrinolysis is an important hemostatic process initiated either by tissue plasminogen activator (tPA) or pro-urokinase (pro-UK) released from endothelial cells. These agents act preferentially on plasminogen by converting it to the active molecule plasmin. This initiates the clot lysis process, which may take several days for completion. Most patients with end-stage renal disease (ESRD) have PTFE grafts for chronic hemodialysis. When these grafts are thrombosed, they are either surgically revised or percutaneously thrombolysed. When these measures fail another access is created without removing the clotted graft. However, it is possible that de-clotting of these thrombosed PTFE grafts can occur spontaneously. Once the graft develops an endothelial lining, these cells can contribute to the fibrinolytic process by secreting tPA or pro-UK. Because this endothelial lining may be less developed than that of a normal vessel, the fibrinolytic process may occur at a slower rate or not at all. Frequent cannulation during hemodialysis can denude existing endothelium, further contributing to the inadequacy of the graft to initiate thrombolysis. In practice, once the PTFE is clotted, the graft is ignored if it is not considered for declotting. In such circumstances the re-canalization process could be overlooked, resulting in the unnecessary placement of additional accesses. Presented here are three patients with clotted grafts in which re-canalization occurred without intervention.
Bridging to a High Flow Upper Arm Native Fistula for Hemodialysis with the LifeSite® Hemodialysis Access System
Authors: Ross J.
Published: January 2018

Permanent vascular access for chronic hemodialysis requires a reliable structure with adequate blood flow. Endogenous arteriovenous (AV) fistulas offer the best outcomes, but standard radiocephalic fistulas are not always feasible. A reliable alternative is a transposed basilic vein-brachial artery AV fistula, which offers a number of advantages over synthetic AV grafts. The transposed basilic vein fistula provides high flow rates along with low rates of infection, thrombosis, and other complications; however, longer maturation times may be necessary. This longer maturation time may necessitate the use of a “bridge device” for access. The new, fully subcutaneous vascular access device - the LifeSite® Hemodialysis Access System - offers several significant advantages over a standard dialysis catheter as a bridge device: higher flow rates without recirculation, as well as lower rates of infection, thrombosis, and hospitalization. This article describes the surgical procedure for the creation of the transposed basilic vein fistula and the implantation procedure for the LifeSite System. We report on the use of this combined sequential approach to vascular access in 14 patients with excellent results. All 14 patients initially implanted with the LifeSite System were successfully bridged to a functional transposed basilic vein fistula. The mean flow rate with the LifeSite System was 450 ml/min; only one device had to be removed due to infection in an HIV-positive patient, and no other complications were observed. The mean time to maturation of the transposed basilic vein fistula was 6 months; the upper arm fistulas delivered a mean flow rate of 1100 ml/min with a 100% patency rate at 6 months. The sequential use of the LifeSite System and a transposed basilic vein fistula represents a valuable approach to increasing the usage of a high flow native AV fistula.
Totally Implantable Central Venous Access: 15 Years’ Experience in a Single Unit
Authors: Craus W. , Di Giacomo A. , Tommasino U. , Frezza A. , Festa G. , Cricrì A.M.
Published: January 2018

The use of Totally Implantable Central Venous Access Systems (T.I.C.V.A.S.) has become an essential aid for those patients requiring extended intravenous infusion treatments or complete parenteral nutrition, and for whom the peripheral venous system may be or may become inadequate for infusions. This paper describes fifteen years of experience in the use of totally implantable systems. It examines the application methods as well as the different systems, complications, patient satisfaction, quality of life, and cost/benefit ratio.

We examined 261 patients observed during a period of approximately 15 years. A surgical team carried out the operations for these patients in an operating room under the strictest asepsis conditions. The Port-a-Cath central venous access systems were used in 221 cases (84.6%) and the Pas-Port peripheral venous access systems were used in 40 cases (15.3%). We observed no particular differences between the different types of systems implanted. The total rate of complications was 11.7%, 0.7% of which were positioning complications, 4.2% stability complications, and 6.1% management complications. There were 2 cases (0.76%) of defective performance of the implanted system. We found patient satisfaction with the method average in 19.85% of the cases, good in 70.23% and excellent in 11.9%. Quality of life improved because of reduced total hospitalization time and more convenient treatment management. Regarding the cost/benefit ratio we also found that the benefits outnumbered costs. In connection with the cost of the system the possibility of home management leads to a marked decrease in hospitalization expenditure. Today these systems should be considered as being essential in the correct management of the patient requiring medium-to-long-term infusion treatment. On the whole these treatments are well accepted by the patient and the possibility of home or day hospital management allows a marked reduction in hospitalization, which affects both social life and costs. The incidence of complications was found to be relatively low considering that most of them are the result of poor management of the system by the paramedical personnel or by the relatives of the patients. In this sense, better education in the management of the system would further optimize results.