Anterolateral Approach Research Articles

Influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following total hip arthroplasty via an anterolateral approach

BackgroundPerioperative greater trochanteric fracture following total hip arthroplasty (THA) using the anterolateral approach is a recognized perioperative complication. There was no previous study to determine the relationship between bone mineral density (BMD) and three-dimensional greater trochanter morphology for perioperative greater trochanter fractures. The purpose of this study is to identify the influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following THA using the anterolateral approach.MethodsWe investigated 209 hips done primary THA using the anterolateral approach and preoperative BMD test for the proximal femoral bone with a minimum of 6 months follow-up. We picked up all patients who had perioperative greater trochanteric fractures. Multivariate analysis was done in order to investigate the influence of the greater trochanter young adult mean (YAM) and three-dimensional morphology on perioperative greater trochanteric fractures.ResultsThere were 10 joints (10/209, 4.8%) with perioperative greater trochanteric fractures. Osteosynthesis was required only in one joint (1/209, 0.5%) because the bone fragments were significantly displaced proximally by the gluteus medius. Multivariate analysis showed the combination of Type B femoral shape (in cases where the top of the great trochanter was inside the longitudinal central axis of the planned femoral stem in computed tomography (CT)- based three-dimensional templating) and a YAM of < 80% was the only risk factor for fracture.ConclusionsThe preoperative greater trochanter BMD test (YAM < 80%) and three-dimensional femoral morphology (Type B femoral shape) provide useful information to mitigate the occurrence of perioperative greater trochanter fractures associated with THA using the anterolateral approach.

Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center

BackgroundPatients who have spinal stiffness and deformity are at the highest risk for dislocation after total hip arthroplasty (THA). Previous reports of this cohort are limited to antero-lateral and postero-lateral (PL) approaches. We investigated the dislocation rate after direct anterior (DA) and PL approach THA with a contemporary high-risk protocol to optimize stability. MethodsWe investigated patients undergoing THA who had preoperative biplanar imaging from January-December 2019. Patients were identified using radiographic criteria of spinal-stiffness (<10-degree change in sacral slope from standing to seated) and deformity (flatback deformity with >10-degree difference in pelvic incidence and lumbar lordosis). There were 367 patients identified (181 DA, 186 PL). The primary outcome was dislocation rate at 2-years postoperatively. Risk-factors for dislocation were evaluated using logistic regressions (significance level of 0.05). ResultsThere were 6 (1.6%) dislocations in the entire cohort, with low dislocation rates for both DA (0.6%) and PL-THA (2.7%). We observed increased utilization of dual mobility with larger outer head bearings (>38 mm) with PL-THA (34.4 versus 5.0%, P < .01) and conversely increased utilization of 32-mm femoral-heads with DA-THA (39.4 versus 7.0%, P < .001). Surgical approach (PL) was not a significant risk-factor for dislocation (odds ratio: 5.03, P = .15). Patients who had a history of lumbar-fusion had 8-times higher odds for dislocation (OR: 8.20, P = .020). ConclusionsTo the best of our knowledge, this is the largest series to date evaluating DA and PL-THA in the hip-spine 2B-group. Our results demonstrate lower dislocation rate than expected with either surgical approach using a high-risk protocol.

The Anatomical Course of the Superior Gluteal Vessel Bundle with Regard to Different Approaches in Total Hip Arthroplasty

BackgroundIatrogenic vascular injury during total hip arthroplasty (THA) is rare, reported at rates of 0.05 to 0.3%, but a potentially limb-threatening and life-threatening complication. We aimed to describe safe and danger zones for the superior gluteal vessel bundle (SGV bundle) with reference to different THA approaches. MethodsThere were 27 formalin-fixed cadavers with 49 hemipelves dissected. The course and distribution of the SGV bundle were investigated with the help of anatomical landmarks like the greater trochanter, the iliac tubercle (IT), and the ischial tuberosity. ResultsWe found and exposed the SGV bundle in all 49 specimens with no sex-specific differences. No SGV bundle was encountered up to 28 mm from the greater trochanter and up to 16 mm below the IT. The zone with the highest probability of finding the vessels was 25 to 65 mm below the IT in 39 (80%) cases – defining a danger zone (in relation to the skin incision) in the proximal fourth for the direct anterior approach, in the proximal half for the antero-lateral approach, in the proximal fifth for the direct lateral approach, and almost no danger zone for the posterior approach. ConclusionsSpecial care in proximal instrument placement should be taken during THA. When extending one of the surgical approaches, manipulations in the proximal, cranial surgical window should be performed with the utmost care to avoid SGV bundle injury.

Da Vinci Robotic Assistance for Anterolateral Lumbar Arthrodesis: Results of a French Multicentric Study

BackgroundDa Vinci® robot (DVR®) is today the most widely used robot in visceral, urological and gynecological surgery. Thanks to its minimally invasive approach, it has demonstrated its effectiveness and improved safety in these different disciplines. The aim of our study is to report its use in anterior approach of complex lumbar surgery. Material and MethodThis is a retrospective multicenter observational study. Ten robotic-assisted procedures were performed from March 2021 to May 2022. Six oblique lumbar interbody fusion (OLIF) procedures and four lumbar corporectomies were performed by anterolateral approach assisted by DVR®. The characteristics of the patients as well as the intra- and postoperative data were recorded. ResultsSix men and four women underwent surgery, with a mean age of 50.5 years and a BMI of 28.6 kg/m2. No vascular injuries were reported, and no procedures required conversion to open surgery. Mean surgical time were 219 minutes for 1-level-OLIF (3 patients), 286 minutes for 2-level-OLIF (3 patients), and 390 minutes for corporectomy (4 patients). Four patients experienced non-serious adverse events due to lumbar plexus nerve damage. One patient had a vertebral body plate fracture requiring posterior revision surgery, and one patient had a psoas hematoma requiring transfusion. No abdominal wall complications or surgical site infection were found. Seven patients were reviewed at 12 months, none had complications, and all showed radiological evidence of fusion. ConclusionThe use of DVR® in lumbar surgery allows a safe minimally invasive trans-peritoneal approach, but to date, it only allows hybrid procedures to be performed.

Treatment of symptomatic end-stage osteoarthritis of the ankle with anterolateral approach and an anatomical plate

The aim of this paper is to describe the anterolateral approach using an anatomical plate for ankle arthrodesis and to present the first mid-term results with this technique in ahigh-risk population. The indication for arthrodesis of the ankle joint with this described technique is moderate to severe osteoarthritis of the ankle. In addition to the general contraindications typical of any operation, there is a specific contraindication in cases of active infection of the soft tissues and accompanying osteomyelitis at the ankle. The incision is made along the course of the peroneus tertius muscle. After that, the mobilization of the peroneus superficialis nerve is carried out, followed by the mobilization of the long extensor tendons, especially the extensor digitorum muscle in amedial direction opening the capsule and removal of the residual cartilage on the distal tibia and talus. Subsequently, the subchondral sclerosis is opened, and the implantation of a suitable osteosynthesis material, e.g., an anatomical angle-stable plate, is carried out. Finally, wound closure is performed involving the muscle belly of the extensor digitorum muscle covering the plate. Immobilization of the ankle for 5-7days in adorsal knee-high splint. Retention in awalker after decongestion for another 5weeks. Increased loading can be done after X‑ray/computed tomography (CT) control from the 6thweek. In all, 11patients were observed retrospectively for an average of 14months. There were no complications. The European Foot and Ankle Society (EFAS) score improved significantly from 3.3 to 17.8 points. All patients were subjectively satisfied with the result and would have the operation again.

Efficacy of three different techniques in the fluoroscopy-guided intra-articular steroid injection of the hip: a randomized controlled trial

Fluoroscopy-guided injection via the anterior (A), anterolateral (AL), or proximal anterolateral (PAL) approaches are the common hip injection techniques without comparing the efficacy of the three techniques. The prospective randomized controlled trial was conducted from August 2020 to March 2022. Included patients with intra-articular hip disorders indicated an intra-articular steroid injection. Excluded significant spine pathology with radiculopathy or significant neurological deficits, previous hip surgery of the injection side, suspected tumor or infection origins, steroid or contrast media allergy, and body mass index > 35 kg/m2. The primary outcome was the injection attempt defining one attempt and multiple attempts. 90 patients were recruited and allocated to 30 per group. There were no differences between A, AL, and PAL respectively regarding the success in one attempt rate (80%, 80%, 90%; p = 0.533), VAS during local anesthetic injection (4.33 ± 1.99, 3.70 ± 2.34, 4.27 ± 2.49; p = 0.500), VAS during intra-articular injection (4.27 ± 1.87, 4.70 ± 2.37, 4.13 ± 2.37; p = 0.587), radiation doses (0.558 ± 0.313, 0.526 ± 0.485, 0.492 ± 0.275 mGy; p = 0.788), radiation time (0.043 ± 0.017, 0.039 ± 0.021, 0.041 ± 0.015 seconds; p = 0.723), and complications. The post-injection mHHS was improved in all three approaches without significant differences.

Anterolateral upper cervical approach for ventral C1-C2 meningioma.

The surgical management of ventral upper cervical meningiomas poses significant challenges due to their deep location and limited accessibility. These tumors have the potential to compress or involve nearby neurovascular structures, leading to various neurological complications including inferior cranial nerve palsy, motor deficits, and sensory disturbances such as hypoesthesia, paresthesia, and impaired coordination. To address this issue, surgical intervention through an anterolateral or far lateral approach has been recognized as the optimal treatment strategy. In this video, the authors present a detailed demonstration of the operative technique using an anterolateral upper cervical approach to safely resect a ventrally located C1-2 meningioma.

Reappraisal of the anatomy of the frontotemporal branches of the facial nerve.

The anatomy of the temporal branches of the facial nerve (FN) has been widely described in the neurosurgical literature because of its relevance in anterolateral approaches to the skull base and implication in frontalis palsies from these approaches. In this study, the authors attempted to describe the anatomy of the temporal branches of the FN and identify whether there are any FN branches that cross the interfascial space of the superficial and deep leaflets of the temporalis fascia. The surgical anatomy of the temporal branches of the FN was studied bilaterally in 5 embalmed heads (n = 10 extracranial FNs). Exquisite dissections were performed to preserve the relationships of the branches of the FN and their relationship to the surrounding fascia of the temporalis muscle, the interfascial fat pad, the surrounding nerve branches, and their final terminal endpoints near the frontalis and temporalis muscles. The authors correlated their findings intraoperatively with 6 consecutive patients with interfascial dissection in which neuromonitoring was performed to stimulate the FN and associated twigs that were observed to be interfascial in 2 of them. The temporal branches of the FN stay predominantly superficial to the superficial leaflet of the temporal fascia in the loose areolar tissue near the superficial fat pad. As they course over the frontotemporal region, they give off a twig that anastomoses with the zygomaticotemporal branch of the trigeminal nerve, which crosses the superficial layer of the temporalis muscle, spanning the interfascial fat pad, and then pierces the deep temporalis fascial layer. This anatomy was observed in 10 of the 10 FNs dissected. Intraoperatively, stimulation of this interfascial segment yielded no facial muscle response up to 1 mA in any of the patients. The temporal branch of the FN gives off a twig that anastomoses with the zygomaticotemporal nerve, which crosses the superficial and deep leaflets of the temporal fascia. Interfascial surgical techniques aimed at protecting the frontalis branch of the FN are safe in their efforts to protect against frontalis palsy with no clinical sequelae when executed properly.

Trauma

The October 2023 Trauma Roundup360 looks at: Intramedullary nailing versus sliding hip screw in trochanteric fracture management: the INSITE randomized clinical trial; Five-year outcomes for patients with a displaced fracture of the distal tibia; Direct anterior versus anterolateral approach in hip joint hemiarthroplasty; Proximal humerus fractures: treat them all nonoperatively?; Tranexamic acid administration by prehospital personnel; Locked plating versus nailing for proximal tibia fractures: a multicentre randomized controlled trial; A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Augmentation plate without bone graft in the management of distal tibial diaphyseal non-union

PurposeThe objective of this study was to assess the efficacy of augmentation plating with retaining of previous implant in situ in cases of non-united oligotrophic or atrophic aseptic distal tibial diaphyseal and metaphyseal fractures without bone grafting depending on the unified bone healing and non-union theory. MethodsThrough the period between December 2019 and December 2022, twelve patients with distal third tibial non-unions who were fixed at time of fracture either by intramedullary interlocking nails (seven cases) or by minimally invasive plate osteosynthesis (five cases) were included. Non-union was diagnosed on basis of absence of any healing progression in three months period or absence of fracture healing after six months from index surgery. All patients had oligotrophic or atrophic non-union. Augmentation plating through an anterolateral approach was done on average of 7.25 months after initial surgery (6–9 months). Circumferential exposure of the fracture site and debridement of fibrous tissue were not necessary. No bone grafting was done as no cases had major bone defect. ResultsAll patients achieved complete radiological union with a mean time of 21.8 weeks (range 18–30 weeks) that mean full callus formation in all cortices. All patients were walking independently after three months (13weeks) from surgery and returned to work even in cases of absent complete radiological union. No cases had been complicated with wound healing problems (infection or dehiscence). One patient had incomplete ankle dorsiflexion (10°) due to tight calf muscles and one patient had paresthesia on the dorsum of the foot that was not improved at last follow up (one year after surgery). ConclusionAugmentation plating is a safe and effective option for management of distal tibial diaphyseal nonunion even in cases of oligotrophic or atrophic non-union.

Surgical Treatment of Thoracolumbar Pott’s Disease at Niamey National Hospital (HNN) about 34 Cases

Pott's disease or tuberculous spondylodiscitis is one of the most serious forms of osteoarticular tuberculosis, responsible for spinal cord compression and/or "cauda equina" syndrome due to granulomatous and/or abscessed tuberculous epiduritis. Surgery therefore plays a key role in the management of this pathology, although surgical techniques vary widely from one author to another and from one department to another.&#x0D; The aim of our work is to describe the different techniques used in our department during the study period, and to evaluate the results.&#x0D; This is a prospective study concerning 34 cases of dorsolumbar and lumbar Pott's disease collised in the neurosurgery department of Niamey National Hospital from January 2020 to December 2021.&#x0D; Analysis of our results found 26 men and 8 women with a sex ratio of 3.25; the extreme ages were 11 and 76 years and the mean age was 40.53 years. 20 patients presented with dorsal cord compression syndrome, 12 with cauda equina syndrome, 6 with conus medullaris syndrome and 2 with multifocal localization.&#x0D; CT was performed in all patients and MRI in only one. All patients were treated with antibacillary chemotherapy. In 16 patients (47.06%), a posterolateral approach consisting of hemilaminectomy, pediculotomy and unilateral arthrectomy was used; in 9 patients (26.47%) a posterior approach consisting of fenestration; and laminectomy in 4 patients (11.76%). An anterior approach in 3 patients (8.82%), consisting of a corpectomy and an antero-lateral approach (pediculo-artrectomy-corpectomy) in 2 patients (5.89%). All our patients underwent debridement, evacuation of residual pus and sequestrectomy. Out of the debridement filling of the defect was performed in 23 cases with a spinous graft, 2 with fibula, 2 with a rib graft and one with an iliac bone graft.&#x0D; At 4 months post-surgery, radicular signs had completely disappeared in all patients, and sensory-motor deficit had improved in 30 patients (88.23%). There was a reduction in kyphosis in all patients who had benefited from an anterior approach, compared with 41.38 % who had undergone a posterior approach.

Identifying risk factors for osteonecrosis after talar fracture.

To identify patient, injury, and treatment factors associated with development of avascular necrosis (AVN)following talar fractures, with particular interest in modifiable factors. Retrospective chart review. 21 US trauma centers and 1 UK trauma center. 2,220 patients with talar neck and/or body fractures. Open reduction internal fixation of talar neck and body fractures. Development of AVN. Infection, nonunion, and arthritis were secondary outcomes. 796 patients (408 M; 388 F; age 18-81, avg 38.6) with 796 (532R; 264L) fractures were included and were classified as Hawkins 1(51), IIA(71), IIB(113), III(158), IV(40), neck plus body (177), body (188). 336/798 developed AVN (42%), more commonly following any neck fracture (47.0%) vs isolated body fracture (26.1%, p<0.001). More severe Hawkins' classification, combined neck and body fractures, body mass index (BMI), tobacco smoking, right-sided fractures, open fracture, dual anteromedial and anterolateral surgical approaches, and associated medial malleolus fracture were associated with AVN. After multivariate regression, fracture type, tobacco smoking, open fractures, dual approaches, age, and BMI remained significant.Excluding late cases (>7 days), time to joint reduction for Hawkins type IIB-IV neck injuries was no different for those who developed AVN or not. AVN rates for reduction of dislocations within 6 hours of injury vs >6 hours were 48.8% and 57.5%, respectively. Complications included 60 (7.5%) infections and 70 (8.8%) nonunions. 42% of all patients developed AVN, with talar neck fractures, more displaced fractures and open injuries having higher rates. Injury-related factors are most prognostic of AVN risk. Surgical technique to emphasize anatomical reduction, without iatrogenic damage to remaining blood supply is essential. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Mini open anterolateral rotator cuff tear repair with the help of suture anchor

Background: It is generally accepted that mini open rotator cuff tear repair with the help of suture anchor gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of good structural and functional outcome. The purpose of this study is to asses functional outcome of mini-open anterolateral rotator cuff tear repair with the help of suture anchor. Method: The 30 consecutive rotator cuff tear patients were selected from outpatient department at medical college. All patients were diagnosed with full thickness rotator cuff tear and subsequently treated with mini-open anterolateral approach technique. Each patient was clinically assessed with DASH questionnaire and constant Murley score for their satisfaction. Results: After a minimum of 12 month follow up period, the average clinical outcome scores all improved significantly at the time of final follow up. Conclusions: Patient with mini-open anterolateral rotator cuff tear repair with the help of anchor suture showed improvement in their functional outcome and range of motion.

Anterior Total Hip Arthroplasty With Gluteus Medius Repair: A Novel Technique

Introduction: Proper function of the gluteus medius muscle is crucial to performance and outcomes following total hip arthroplasty. Gluteus medius tears are reported in up to 20% of patients undergoing hip replacements. The combination of increasing notoriety for the direct anterior approach and the potential for improved patient outcomes necessitates a technique to address gluteus medius tears in conjunction with total hip arthroplasty. Therefore, we present the following novel technique for transtendinous gluteus medius repair in conjunction with a direct anterior approach for total hip arthroplasty. Technique: The patient is placed supine with the operative leg in slight external rotation. An incision is made to the fascia overlying the tensor fascia latae. Blunt dissection is performed to the tensor fascia latae-sartorius interval. The deep rectus fascia is split, identifying the anterior capsule. Arthroplasty is then performed in the usual manner. Once the arthroplasty is completed, the hip capsule is closed, and the gluteus medius is exposed through an anterolateral approach. Once found, the tear is classified. A split in line with the tendon fibers is made in the mid aspect of the tear. Once visualized, the greater trochanter is decorticated, and suture anchors are placed. Sutures are passed and tied sequentially from distal to proximal. Expected Outcomes: Gluteus medius repair patients experience excellent outcomes, with multiple studies showing decreased pain and restoration in the strength of the abductor complex. In the setting of total hip arthroplasty, most patients display adequate abductor strength and no Trendelenburg gait at 5 years postoperative.

Comparative evaluation of the clinical efffcacy and safety of surgical approaches in total hip arthroplasty

Background Advanced coxarthrosis is a leading cause of disability in patients. Total arthroplasty is regarded as the "gold standard" for the treatment of hip pathologies that are not amenable to conservative treatment. Arthroplasty introduced into clinical practice has significantly improved functional status of patients. The data are largely contradictory and indicate certain difficulties and risks at the stages of treatment and rehabilitation of patients after surgery. The shortcomings can be overcome by improving the treatment methods for the cohort of patients based on the results of large-scale comparative studies exploring the effectiveness of different approaches to all stages of treatment of arthroplastic patients.The objective was to search for the most justified and promising surgical approaches in terms of clinical efficacy and safety of total hip arthroplasty (THA).Material and methods The search for publications was produced using the databases of Scopus, PubMed and the electronic scientific library eLIBRARY in Russian and English languages using the keywords: total hip arthroplasty, minimally invasive approach, anterolateral approach in THA, direct lateral approach in THA, posterior approach in THA, comparative assessment of approaches in hip arthroplasty, advanced replacement techniques, incidence of postoperative complications in THA, direct anterior approach in THA.Results and discussion A number of studies have shown that interventions using direct anterior access (DAA) are characterized by less blood loss, less frequent blood transfusions, less operating time and shorter hospital stay. There was a more rapid recovery of the hip function during early postoperative period with less need for opioid analgesics with DAA. Complication rate was higher with DAA than in the comparison group, which directly correlated with the learning curve.Conclusion DAA was shown to be an advanced approach that resulted in enhanced clinical efficacy and safety of surgical treatment in the majority of patients with coxarthrosis with sufficient experience of the surgeon. The method can be considered as low-traumatic. Unlike other approaches, DAA was accompanied by less injury to intact tissues; smaller skin incision; less blood loss; precipitated postoperative rehabilitation; less severity of postoperative pain and less need for opioid analgesia. However, DAA is inferior to classical approaches in primarily complicated hip pathologies.

565 The SPAIRE Technique for Hip Hemiarthroplasty - an Alternative Approach to the Hip

Abstract Aim Over 20,000 hip hemiarthroplasties for hip fractures are performed annually in the UK. NICE currently recommends performing these via the anterolateral approach, to reduce the risk of dislocation, with the potential expense of reducing function and mobility post-operatively. To address these issues, muscle-sparing approaches have been utilised and "SPAIRE" (Sparing Piriformis and Internus Repairing Externus) is one of them. Method Retrospective analysis of prospectively collected data over a 10-month period was performed at a single centre. All hip fracture patients who had hip hemiarthroplasty as their primary treatment were included. We collected demographic data, pre- and post- operative mobility status, and time to reach that, surgical approach, duration of surgery and complications. Our primary outcome was the dislocation rate and secondary outcomes were post-operative time to mobilisation and duration of surgery. Results Between October 2021 and August 2022, we identified 194 cases, divided into three groups based on the surgical approach used: SPAIRE = 43, Anterolateral = 97, Posterior = 54. All groups had similar demographics and a minimum two-month follow-up. There were no dislocations in the SPAIRE group, compared to 2 (2%) in the Anterolateral and 2 (3.7%) in the Posterior groups. The mean return to mobility was 1.4 days for "SPAIRE" patients, compared to 2 and 2.6 days for patients in other groups. All three groups had similar mean surgical times (74min, 79min, and 71min respectively). Conclusions The "SPAIRE" approach seems to be lowering the risk of dislocation, and reducing the time to mobilisation, potentially improving function for patients undergoing hip hemiarthroplasty.

Comparison of the intraarticular osteotomy and the “window” osteotomy in the treatment of tibial plateau fracture involving depressed posterolateral fragments

ObjectivesThe methods of reduction of depressed posterolateral fragments in tibial plateau fracture through anterolateral approaches remain controversial. This paper aimed to compare the intraarticular osteotomy technique and the “window” osteotomy technique for the reduction of depressed posterolateral fragments through anterolateral approach.MethodFrom January 2015 to January 2022, we retrospectively reviewed the data on patients with tibial plateau fracture involving depressed posterolateral fragments treated with the intraarticular osteotomy or the “window” osteotomy. 40 patients underwent the intraarticular osteotomy were divided into group A, while 36 patients underwent the “window” osteotomy were divided into group B. The operative time, bone grafting volume, fracture healing time, complication, reduction quality and postoperative functional results were compared between the two groups.ResultsThe average follow-up duration was 16.6 ± 3.7 months. The average bone grafting volume for all patients in group B was essential larger than group A (p = 0.001). Compared to group B, patients in groups A had significantly shorter fracture healing time (p = 0.011). The depth of depressed articular surface, PSA and the radiographic evaluation at 2 days and 6 months after surgery in group A were significantly lower than group B (p<0.05). Based on the HSS knee-rating score, no significant difference in function results was found between the two groups (p>0.05). No significant difference was found in operation time and blood loss between the two groups (p>0.05).ConclusionThe intraarticular osteotomy could obtain satisfactory clinical results in tibial plateau fracture involving posterolateral fragments.

Total Hip Arthroplasty in An Orthopedic Institution in Cuba

Introduction: Total, hip arthroplasty is a safe and effective procedure. It relieves pain, as well as improves physical health and quality of life in patients undergoing it. Purpose: Study that allows to determine and show some characteristics of patients and the procedure, who underwent total hip arthroplasty in an important specialized institution in Cuba. Design: Retrospective descriptive study with patients who underwent total hip arthroplasty in a hospital specializing in Orthopedics and Traumatology in Cuba; the "Fructuoso Rodríguez" Teaching Orthopedic Hospital, between September 2019 and March 2021. Results: Predominance of the female sex between the ages of 60 and 62 with left laterality. The main preoperative diagnosis was coxarthrosis, the size of the acetabular cup and the head of the femoral component were very similar, with pressure fixation of the acetabular prosthesis. The posterolateral approach was used, in addition to the lateral, anterolateral and anterior approaches. Conclusions: Great similarities were found in relation to the variables age, sex, laterality, size of the acetabular components and femoral head, type of fixation of the acetabular component and number of screws used in it. Only in three used an anterior approach to the hip.

The Effect of Surgical Approach on the Outcomes of Same-Day Discharge Outpatient Total Hip Arthroplasty at a Single Ambulatory Surgery Center

BackgroundPrimary total hip arthroplasty (THA) is increasingly being performed in the outpatient setting. However, there is little known regarding the differences in same-day discharge (SDD) rates and complications of operative approach in same-day total hip arthroplasty in the ambulatory surgery center (ASC) setting. MethodsA retrospective chart review was performed between July 2019 and October 2021 for all patients who underwent primary THA in a single freestanding ASC. Successful SDDs, surgical approaches, lengths of surgery, estimated blood losses (EBL), complications, and readmission events were recorded for each patient. Complications were compared using Pearson Chi-Squares, while EBL and surgery lengths were compared with 1-way analysis of variances (ANOVA) (alpha = 0.5). There were 17 total complications in 326 total hip arthroplasties (5.2%), including direct admissions to the emergency department, 30-day and 90-day readmissions, wound complications, instability, infection, and revision surgery. Among all complications, there were 5 direct admissions, making the successful SDD rate 98.5%. ResultsComplications and direct admissions were not associated with approach. The 30-day readmission rates were associated with approach, with no readmissions in the direct anterior approach (DAA) or the antero-lateral approach (AL) cohorts and 3 (4.3%) in the posterior approach (PA) cohort. ConclusionsIn the ASC setting, patients undergoing THA regardless of approach showed no difference in successful SDDs or complications aside from 30-day readmissions. Same-day THA can be safely performed in the DAA, AL, and PA to the hip.

Rim plate in the treatment of hyperextension tibial plateau fracture: surgical technique and a series of cases

BackgroundThe existence of a “bare area” at the anterior plateau has been observed in cases where anteromedial and/or anterolateral proximal tibial locking plates are used for fixation in the treatment of hyperextension tibial plateau fractures (HTPF). The objective of this study is to introduce the rim plate fixation technique and evaluate its clinical efficacy.MethodsA retrospective analysis was conducted on HTPF patients who underwent treatment with a combination of rim plate and proximal tibial locking plate at our hospital between April 2015 and December 2019. All patients were followed up for a minimum of one year. Open reduction and internal fixation were performed using anteromedial/posteromedial and/or anterolateral approaches for all cases. The surgical strategies employed for rim plate fixation were introduced, and both radiographic and clinical outcomes were assessed.ResultsThirteen patients were enrolled in the study, with an average follow-up time of 4.3 years. Satisfactory reduction was achieved and radiographically maintained in all cases. Additionally, all patients exhibited satisfactory clinical functions, as evidenced by a mean hospital for special surgery (HSS) knee score of 96.2 ± 2.0 (range: 90–98). Furthermore, no wound complications or implant breakage were observed in this series.ConclusionThe combination of the rim plate and proximal tibial plate proved to be an effective fixation configuration, resulting in satisfactory clinical outcomes.