Anterolateral Surgical Approach Research Articles

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.

CT validation of intraoperative imageless navigation (Naviswiss) for component positioning accuracy in primary total hip arthroplasty in supine patient position: a prospective observational cohort study in a single-surgeon practice

BackgroundThe aim of this study was to report on the validity of the Naviswiss handheld image-free navigation device for accurate intraoperative measurement of THA component positioning, in comparison with the three-dimensional (3D) reconstruction of computed tomography (CT) images as the gold standard.MethodsA series of patients presenting to a single-surgeon clinic with end-stage hip osteoarthritis received primary hip arthroplasty with the anterolateral muscle-sparing surgical approach in the supine position. Imageless navigation was applied during the procedure with bone-mounted trackers applied to the greater trochanter and ASIS. Patients underwent routine CT scans before and after surgery and these were analyzed by using three-dimensional reconstruction to generate cup orientation, offset and leg length changes, which were compared to the intraoperative measurements provided by the navigation system. Estimates of agreement between the intraoperative and image-derived measurements were assessed with and without correction for bias and declared cases with potential measurement issues.ResultsThe mean difference between intraoperative and postoperative CT measurements was within 2° for angular measurements and 2 mm for leg length. Absolute differences for the two indices were between 5° and 4 mm. Mean bias was 1.9°–3.6° underestimation for cup orientation and up to 2 mm overestimation for leg length change, but absolute thresholds of 10° and 10 mm were not exceeded by 95% limits of agreement (LOA), especially after correction for bias. Four cases (12%) were declared intraoperatively for issues with fixation on the greater trochanter. Inclusion of these cases generated acceptable accuracy overall and their omission failed to improve between-case variability in accuracy or LOA for both offset and leg length.ConclusionsThe accuracy of the Naviswiss system applied during primary THA in a supine position and anterolateral surgical approach falls within clinically acceptable recommendations for acetabular cup placement, femoral offset, and length. With refinements to surgical technique to adapt to the navigation hardware, the system could be further improved with regression-based bias correction.Trial registrationRegistered with the Australian New Zealand Clinical Trials Registry (ACTRN12618000317291)

Comparison of Posterior and Anterolateral Surgical Approaches in Treating Adult Humeral Shaft Fractures.

The purpose of this study is to compare the outcomes and complications of two different surgical approaches, the anterolateral and posterior approaches, for treating humeral shaft fractures. Between January 2015 and May 2021, 51 patients with humeral shaft fractures were treated with anterolateral and posterior approaches. Twenty-nine patients were operated with the posterior approach (group 1) and 22 with the anterolateral approach (group 2). Statistical analyses were performed between the two groups regarding age, gender distribution, fractured side, body mass index (BMI), type of trauma, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification, and follow-up time. Complications such as operative time, amount of bleeding, incision length and implant fracture, radial nerve palsy, wound infection, and nonunion were compared between the two groups. Functional results of the elbow joint were evaluated with the Mayo Elbow Performance Score. The mean follow-up period was 49.10±21.15 months (12-75 months) in group 1 and 50.00±23.71 months (range: 15-70 months) in group 2. There was no statistical difference between the groups in terms of age, gender distribution, fractured side, BMI, trauma type, AO/OTA classification, and follow-up time (p>0.05). There was no significant difference between the two groups in terms of operation time, intraoperative bleeding, and incision length (p>0.05). The mean Mayo Elbow Performance Score was 77.24±20.03 (range: 70-100 points) in group 1 and 81.36±8.34 (range: 70-100 points) in group 2, and no significant difference was found (p>0.05). When evaluated in terms of complications, there was no significant difference between the groups (p>0.05). While there was no significant difference between the two groups regarding elbow joint range of motion, the limitation was observed in more patients in group 1. Similar satisfactory treatment results were obtained in patients who underwent anterolateral and posterior approaches in treating humeral shaft fractures. Furthermore, no difference was found between the two approaches regarding complication rates.

Outcome of management of tibial plateau fracture by posterior Lobenhoffer approach: case series.

Displaced Tibiai plateau fractures are complex periarticular injuries. Restoration of the anatomy and internal fixation are key elements for early return to function and better functional outcome. Newer modalities like CT scans has enabled better understanding of these fractures. Posterior approaches were not very common as compared to anteromedial and anterolateral surgical approach. Posterior approach has the advantage of avoiding anterior skin and soft tissues that has been compromised as a result of the fracture; it is also particularly helpful in direct and accurate reduction in certain fracture patterns. This case series highlights the importance of posterior approach to restore the articular surface of complex periarticular proximal Tibial fractures. All displaced tibial plateau fractures with posteromedial fragment were included in the study. Pathological fractures and all open fractures were excluded from this study. Oxford Knee score was done at regular intervals for functional outcome assessment. No wound complications or iatrogenic neurovascular damage were observed with this approach in this series. Anatomical reduction and radiological union was obtained in all patients with excellent functional outcome. We recommend posterior Lobenhoffer approach for fixation in select group of patients with Tibial plateau fractures.

Acetabular Reaming Is a Reliable Model to Produce and Characterize Periarticular Heterotopic Ossification of the Hip.

Heterotopic ossification (HO) is a pathologic process characterized by the formation of bone tissue in extraskeletal locations. The hip is a common location of HO, especially as a complication of arthroplasty. Here, we devise a first-of-its-kind mouse model of post-surgical hip HO and validate expected cell sources of HO using several HO progenitor cell reporter lines. To induce HO, an anterolateral surgical approach to the hip was used, followed by disclocation and acetabular reaming. Animals were analyzed with high-resolution roentgenograms and micro-computed tomography, conventional histology, immunohistochemistry, and assessments of fluorescent reporter activity. All the treated animals’ developed periarticular HO with an anatomical distribution similar to human patients after arthroplasty. Heterotopic bone was found in periosteal, inter/intramuscular, and intracapsular locations. Further, the use of either PDGFRα or scleraxis (Scx) reporter mice demonstrated that both cell types gave rise to periarticular HO in this model. In summary, acetabular reaming reproducibly induces periarticular HO in the mouse reproducing human disease, and with defined mesenchymal cellular contributors similar to other experimental HO models. This protocol may be used in the future for further detailing of the cellular and molecular mediators of post-surgical HO, as well as the screening of new therapies.

Prosthetic Reconstruction for Proximal Tibial Osteosarcoma with an Anterolateral Surgical Approach: Case Report

Prosthetic Reconstruction for Proximal Tibial Osteosarcoma with an Anterolateral Surgical Approach: Case Report

Анатомо-клиническое обоснование заднего хирургического доступа для остеосинтеза при переломах задних отделов латерального мыщелка большеберцовой кости

Introduction Conventional anterolateral surgical approach to the lateral tibial condyle has been well studied and proven safe. However, this approach does not provide adequate visualization for performing a good quality osteosynthesis in fractures located in the posterior segment of the lateral condyle. Purpose of the investigation was a rationale of plate implantation technique on the posterior surface of the lateral tibial condyle from the posterior approach with anatomical and clinical demonstration of its technical feasibility and safety. Materials and methods The study was conducted on 10 knee joints of six unfixed cadavers. We implanted a T-plate on the posterior surface of the lateral tibial condyle using a posterior surgical approach. After that soft tissues were dissected to explore the exact location and the distances between the plate and crucial anatomic structures of the region. Five patients underwent surgical treatment of tibial plateau fractures 41C3 type following AO/OTA classification or Schatzker classification type V using the described method. The patients were followed-up for nine months after surgery. Results were evaluated using the KSS and Lysholm scales. Results The study on cadavers showed safety and feasibility of the surgical technique developed. We did not encounter specific complications associated with posterior plate implantation. All fractures healed after nine months postsurgery. The functional outcomes according to KSS scale were excellent in four cases and good in one case; according to Lysholm scale, three were excellent, one good and one fair outcome. Discussion In spite of the simplicity of the conventional anterolateral approach, many investigators tend to use different modifications of posterior approaches for the posterior lateral tibial condyle fixation. This method provides better reduction and fixation using a buttress plate. Our investigation showed safety and feasibility of this technique for fixation of the posterior segment of the lateral tibial condyle. The technique proposed, if performed properly, provides safe and accurate osteosynthesis and prevents secondary displacements of fragments in the rehabilitative period.

Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study.

BackgroundThe aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus.Material/MethodsThis study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up.ResultsThe posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II.ConclusionsThe anterolateral approach showed an advantage over the posterior approach for treating simple humeral mid-shaft fractures. However, this advantage was not observed in treating comminuted fractures.

A choice of surgical approach for osteosynthesis in fractures of the lateral tibial condyle

Intention. To conduct a comparative analysis of the dynamics of the consolidation of intraarticular fractures of the posterolateral parts of the lateral tibial condyle, the anatomical and functional outcomes of surgical treatment of these patients after plate osteosynthesis with traditional anterolateral and posterolateral transfibular surgical approaches as well.Methodology. A comparative prospective study of the effectiveness of osteosynthesis in patients with fractures of the posterolateral part of lateral tibial condyle in two compatible clinical groups was performed in dynamics for periods of 7–10 days, 1, 3, 6 and 9 months after surgery. In the first group (25 patients), bone osteosynthesis was performed from traditional anterolateral approach (TALA), and in the second group (20 patients), from the posterolateral transfibular approach (PLTFA). The average duration of osteosynthesis operations was compared. The displacements of fragments of the articular surface of the lateral tibial condyle, the indices of the KSS and Lysholm scales, the results of measurements of the angle of flexion and valgus stress test of the knee joint were evaluated. Data processing was performed using the Data Analysis and Chart Master modules (Excel), the Basic Statistics / Tables module (Statistic for Windows) as well.Results and Discussion. In the PLTFA group, the average operation time was (81.0 ± 8.5) minutes (from 67 to 96 minutes), in the TALA group, the duration of operations was 35.8 % longer and averaged (110 ± 5.2) minutes (from 82 to 125 minutes) (p &lt; 0.05). The values of the KSS and Lysholm scales in dynamics showed a steady and statistically significant (p &lt; 0.01) increase with increasing time after surgery without significant differences between the groups. The angle of flexion of the knee joint increased more rapidly during the first three months, then the rate decreased from 6 to 9 months (p &lt; 0.05) without significant differences between the groups. The frequency of displacements of fragments of the articular surface in the first group was statistically significantly (p &lt; 0.05) higher than in the second group. Differences in the valgus-stress test indices in both groups reached a maximum after 9 months – 52 and 30 %, respectively.Conclusion. With PLTFA, surgery duration decreases, articular surface fragments are better reduced, and their subsequent displacement at the stages of treatment is less likely; therefore, this approach is preferable for osteosynthesis of fractures of the posterolateral parts of the lateral tibial condyle.

A New Approach to Surgical Management of Tibial Plateau Fractures.

Tibial plateau fractures (TPFs) are challenging, requiring complex open reduction and internal fixation (ORIF) and are often associated with complications including surgical site infections (SSIs). In 2007, we introduced a novel management protocol to treat TPFs which consisted of an angiosome- or perforator-sparing (APS) anterolateral approach followed by unrestricted weight bearing and range of motion. The primary aim of this retrospective study was to investigate complication rates and patient outcomes associated with our new management protocol. In total, 79 TPFs treated between 2004 and 2007 through a classic anterolateral surgical approach formed the “Classic Group”; while 66 TPFS treated between 2007 and 2013 formed the “APS Group”. Fracture reduction, maintenance of reduction and patient-reported outcomes were assessed. There was a clinically important improvement in the infection incidence with the APS (1.5%) versus the Classic technique (7.6%) (1/66 versus 2/79 for superficial infections; 0/66 versus 4/79 for deep infections). Despite a more aggressive rehabilitation, there was no difference in the fracture reduction over time or the functional outcomes between both groups (p > 0.05). The APS anterolateral approach improved the rate of SSIs after TPFs without compromising fracture reduction and stabilisation. We continue to use this new management approach and early unrestricted weight bearing when treating amenable TPFs.

FIXATION OF POSTERIOR TIBIAL PLATEAU FRACTURE AND ITS OUTCOME: A COMPARATIVE STUDY

Introduction: Tibial plateau fractures are complex injuries of proximal tibia which are produced by high- or low-energy trauma and principally affect young adult population. These fractures usually have associated soft-tissue lesions affecting the treatment. Posterior tibial plateau fractures (PTPF), may be medial or lateral, are common and they occur in about 28.8% patients as a part of bicondylar tibial plateau fractures. These fractures are difficult to reduce, therefore articular incongruity was not found to be detrimental factor in final functional outcomes. Studies have supported the fact that residual articular incongruence is well tolerated by proximal tibial plateau fracture in the form of minimal functional limitation or onset of arthrosis. Anterolateral and anteromedial surgical approaches do not show adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is advised to reduce and fix the fracture through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement. &#x0D; Material and Methods: This comparative prospective cohort study on done on 50 adult patients. Two groups were formed: Group A – double-plate fixation with both posterior and anterolateral having 25 participants and Group B – single anterolateral plate fixation having 25 participants in PTPFs were followed up to 1 year. For Group A, the reduction was done under direct vision and assisted with fluoroscopy in two planes. The reduction was assessed with submeniscal approach. In Group B posterior fragment was reduced by screws through the anterolateral plate followed by CT scan. Patients were evaluated by radiographs every 6 weeks till fracture union is evident. Fracture union was assessed by cortical continuity and progressive loss of fracture line on X-rays. Functional status at 1-year postoperative CT scanogram was done at final follow up to record articular subsidence, nonunion, coronal, or sagittal deformities. Knee functions were assessed by the International Knee Documentation Committee 2000 subjective knee evaluation form and objective functional Knee Society Score (KSS).&#x0D; Results: There were 22 male and 3 female in Group A while in Group B there were 20 male and 5 female. Right tibial fracture was observed in 15 cases and left in 10 cases in group A while in Group B right fracture was seen in 17 cases and in 8 cases left sided fracture. 23 cases each in group A and B were associated with RTA. Operative time (minutes) in group A and group B was 124 ± 26.7 and 79.52± 16.22 respectively. Total mean hospitalization days were 9.4±2.6 in group A and 8.2±1.5 in group B. Union time in group A was 14.6±3.4 weeks while in group B was 15.4±3.2. Statistically significant correlation was observed in group A and B with respect to KSS clinical outcome and KSS functional outcome. Flexion deformity was observed in 3 (12%) cases in group A and in 6 (24%) cases in group B.&#x0D; Conclusion: PTPF can achieve an early and satisfactory functional outcome. Rehabilitation and fracture healing are better in PTPF.&#x0D; Keywords: Tibial plateau fractures, PTPF, Open reduction and internal fixation (ORIF)

Functional Outcome of a Coronal Shear Fracture of the Capitellum Managed by Herbert Screw Fixation Using the Anterolateral Surgical Approach

Fractures of the capitellum, particularly coronal shear fractures, are difficult to manage. The challenges are adequate surgical exposure, proper anatomic reduction, and stable fixation of these fractures. Our study included 10 patients with a coronal shear fracture of the capitellum without any involvement of the posterior condyle. All patients underwent open reduction and Herbert screw fixation using the anterolateral approach, with good functional outcome. In our opinion, this is a good option for the treatment of coronal shear fractures of the capitellum.

The anterior approach for conversion hip arthroplasty.

Conversion of prior proximal femoral fracture fixation to hip arthroplasty is a fairly common and successful procedure, necessitated by various modes of failure. The procedure is well described utilizing a posterior or anterolateral surgical approach. The anterior approach for total hip arthroplasty has gained in popularity. The approach allows for supine positioning and facilitates live fluoroscopic imaging. We present possible advantages and disadvantages, as well as the surgical technique, of conversion to total hip arthroplasty via the direct anterior approach.

VIS-IT: Visualizing the Injured Tibia-A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization.

Posterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector. This position and maneuver take advantage of both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence. In this cadaveric study, we digitally quantified the percentage of the lateral tibial plateau visualized under different conditions after performing an anterolateral surgical approach with submeniscal arthrotomy. Four conditions were assessed for articular visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3) 110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory vector (58.2%, range: 52.9-63.4%). Articular visualization was further improved with the ACL incompetent model (82.4%, range: 77.1-87.7%), modeling a tibial eminence fracture.

Subscapularis Peel for Open Reduction and Internal Fixation of Proximal Humerus Fractures With a Head Split.

Proximal humerus fractures involving an articular head split are rare and complex injuries. In the elderly population, arthroplasty is the optimal treatment, whereas in younger patients, the utility of arthroplasty procedures is limited by concerns of long-term implant survival. As a result, open reduction and internal fixation is still often the first-line treatment option for head-splitting injuries. The traditionally described deltopectoral or anterolateral surgical approaches to the proximal humerus rely on indirect reduction and limited visualization of the articular fragments. We present a case series of younger patients with head-split proximal humerus fractures treated with open reduction and internal fixation through a deltopectoral approach with a subscapularis peel to improve humeral head visualization, reduction, and fixation. The improved reduction may lead to better long-term outcomes and reduce the need for additional surgical procedures. In addition, there were no cases of avascular necrosis in this series.

Equal Primary Fixation of Resurfacing Stem, but Inferior Cup Fixation With Anterolateral vs Posterior Surgical Approach. A 2-Year Blinded Randomized Radiostereometric and Dual-energy X-Ray Absorptiometry Study of Metal-on-Metal Hip Resurfacing Arthroplasty

BackgroundThe anterolateral (AntLat) surgical approach may spare the blood supply to the femoral head and improve the accuracy of cup positioning in metal-on-metal hip resurfacing arthroplasty. Thereby, potentially lessen complications such as avascular head necrosis, femoral neck narrowing and fracture, improve implant fixation, and lessen periprosthetic bone mineral density (BMD) loss. MethodsBetween November 2008 and January 2012, a randomized clinical trial was performed at Aarhus University Hospital. A total of 49 patients (28 males) were allocated to metal-on-metal hip resurfacing arthroplasty by the AntLat (n = 25) or the posterior (Post; n = 24) surgical approach. Patients were followed with radiostereometric analysis, measurements of periprosthetic BMD, clinical outcome scores of Harris hip score and visual analogue scale, serum metal ions, and conventional radiographs. ResultsAt 3 months, cups in the AntLat group had higher total translations of mean 1.00 ± 0.70 mm vs mean 0.64 ± 0.45 mm in the post group (P = .04), and higher total rotations of mean 2.44° ± 1.36° vs mean 1.39° ± 1.17° in the Post group (P = .002). All migrations of cup and stem were similar at 1 and 2 years postoperative (P > .07). At 1 year, periprosthetic BMD since postoperative at the medial side of the stem was reduced to mean 98.45% ± 8.57% in the AntLat group, and increased to mean 105.57% ± 11.07% in the Post group (P = .02), but measurements were comparable at 2 years (P = .05). ConclusionCups inserted by the AntLat approach migrated more until 3 months postoperative. This illustrates a less good primary cup fixation with the AntLat approach; however, all cups were well-fixed after 3 months' follow-up indicating a good secondary fixation.

An Animal Model of Modic Changes by Embedding Autogenous Nucleus Pulposus inside Subchondral Bone of Lumbar Vertebrae.

The establishment of Modic changes (MCs) in animal model was vital for research of MCs. Fifty-four rabbits were divided into a sham group, a muscle embedment group (ME group) and nucleus pulposus (NP) embedment group (NPE group). In the NPE group, the discs were exposed by the lumbar anterolateral surgical approach. A needle was used to puncture the L5 vertebral body close to the endplate. NP was extracted by a syringe from L1/2 intervertebral discs and then injected into the drilled hole of subchondral bone. The muscle embedment group and sham group had the same procedure and drill method as the NP embedment group. Some pieces of muscle were put into the hole in the ME group, but nothing was put into the hole in the sham group. After the operation, MRI scan and molecular biology tests were applied. The signal changes were found in the NPE group; while the sham group and the ME group showed no significant signal change. Histological observation confirmed that there was abnormal tissue proliferation in imbed site. High expression of IL-4, IL-17 and IFN-γ were detected in the NPE group. The embedment of NP into subchondral bone can create an animal model of MCs.

Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics

We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5mm) or non-restored (more than 5mm reduction or more than 5mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5mm resulted in higher Froude number (p<0.001), normalized walking speed (p<0.001) and hip range-of-motion (ROM) (p=0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register.

A new anterolateral surgical approach for total hip replacement.

the purpose of the present paper is to present the short-term results of a "detachment-free" (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. the DF anterolateral approach for THR proved safe and provided effective results at short-term follow-up. Level IV, therapeutic case series.

Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery.

Objectives:To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine.Methods:This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured.Results:The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger (p=0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted.Conclusion:Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations.