Journal of Orthopaedics and Traumatology

Prosthetic joint infection is an infrequent but serious complication of total joint arthroplasty. Complete removal of all foreign material is essential, however when prosthesis removal is not possible or is contraindicated, suppressive antibiotic therapy with retention of the functioning hip arthroplasty may be considered. Linezolid, the first approved oxazolidinone, appears to be a promising new agent for the treatment of serious gram-positive infections. We report two cases of prosthetic hip infections with methicillin-resistant Staphylococcus aureus (MRSA) that were successfully treated with long courses of linezolid. This observation suggests that linezolid is a promising drug for the treatment of prosthetic joint infections due to MRSA or other gram-positive bacteria, particularly when other therapeutic approaches are not feasible or a long-term antibiotic therapy is required.

The linea aspera is the rough, longitudinal crest on the posterior surface of the femoral shaft. Most orthopedic surgeons depend on the linea aspera as an intraoperative landmark identifying the true posterior aspect of the femur. We investigated the position of the linea aspera to verify whether the surgeon can rely on this accepted belief. One hundred and thirty-three femora from 73 patients were evaluated. Four CT cuts were done of the mid femur, and we measured the angle of rotation of the linea aspera at each cut. The linea aspera was externally rotated in most femora evaluated; average angles of rotation were 15.4°, 14°, 11.7°, and 11.5° at 10, 15, 20, and 25 cm from the intercondylar line, respectively. The angle of rotation of the linea aspera was positively correlated with femoral neck anteversion angle and negatively with age. The linea aspera is exactly posterior in a minority of individuals, while it is externally rotated to varying degrees in the majority of individuals. The degree of rotation was positively correlated with femoral neck anteversion angle, and negatively with age. To avoid implant malrotation, accurate estimation of the rotation angle should be determined preoperatively. Level IV.

Việc cấy ghép huyết thanh giả hình yên sau khi cắt bỏ khối u vùng chậu đã được đề xuất như một phương pháp tái tạo đơn giản, cung cấp độ ổn định tốt và giảm thời gian phẫu thuật, từ đó hạn chế tình trạng xảy ra các biến chứng trong phẫu thuật. Chưa có nghiên cứu nào trong tài liệu về việc đánh giá bệnh nhân bằng phân tích đi lại sau khi được cấy ghép huyết thanh giả hình yên. Nghiên cứu hiện tại là một nghiên cứu hồi cứu nhằm minh họa các phát hiện lâm sàng và chức năng lâu dài ở những bệnh nhân ung thư được tái tạo bằng huyết thanh giả hình yên. Một loạt 15 bệnh nhân nhận tái tạo vùng chậu bằng huyết thanh giả hình yên đã được hồi cứu về mặt lâm sàng, hình ảnh và đánh giá chức năng. Hai bệnh nhân đã được đánh giá thêm bằng phân tích đi lại. Theo dõi chức năng lâu dài chỉ được thực hiện ở 6 bệnh nhân, với khoảng thời gian từ 97 đến 167 tháng. Chức năng được phát hiện là khá suy giảm, với trung bình chỉ phục hồi 57% hoạt động bình thường. Phân tích đi lại cho thấy huyết thanh cấy ghép có sinh học cơ thể kém, với vận động hông rất hạn chế. Mặc dù huyết thanh giả hình yên được đề xuất là một bước tiến trong phẫu thuật ung thư liên quan đến vùng chậu, nghiên cứu hiện tại cho thấy rằng nó đem lại kết quả lâm sàng và chức năng không thỏa mãn do cả biến chứng lâm sàng và sinh học cơ thể kém của thiết bị. Việc sử dụng huyết thanh giả hình yên trong phẫu thuật ung thư không cung cấp kết quả thỏa mãn trong theo dõi lâu dài. Nó không còn được cấy ghép tại viện của chúng tôi, và hiện đang được coi là một "kỹ thuật cứu cánh."

This prospective mixed cohort study was designed to evaluate the middle- to long-term purchase of cement-augmented pedicular screws in patients with poor bone quality. The growing number of surgical procedures performed in the spine has highlighted the problem of screws loosening in patients with poor bone stock due to osteoporosis and/or tumors. Different methods of increasing screw purchase have been reported in the literature, including polymethylmethacrylate (PMMA) augmentation. From September 2006 to April 2008, 21 patients with a poor bone stock condition due to osteoporosis or tumor underwent posterior stabilization by fenestrated pedicle screws and PMMA augmentation. Pain improvement and long-term clinical outcome were assessed by visual analogue scale (VAS) score and SF-36 health survey (SF-36) questionnaire. Implant stability was evaluated by plain radiography and CT scans performed three days after surgery and every three months thereafter. After the first 12 months, radiologic controls were taken once a year in all surviving patients. Complications were evaluated in all cases. All patients were clinically and radiographically followed up for a mean of 36 months. VAS scores and SF-36 questionnaires showed a statistically significant reduction in pain and improvement in the quality of life. No radiological loosening or pulling out of screws was observed. In two cases, cement leakage occurred intraoperatively: one patient who suffered from a transitory nerve root palsy improved spontaneously, while the surgeon immediately removed the excess cement before setting in the other case. In three cases, the post-op CT scan revealed a small amount of cement in the canal without clinical relevance. Fenestrated screws for cement augmentation provided effective and lasting purchase in patients with poor bone quality due to osteoporosis or tumors. No case of loosening was recorded after a mean follow-up of 36 months. The only clinical complication strictly related to PMMA screw augmentation did not require further surgery.

The purpose of this study is to analyse and report the mid-term results of 175 unicompartmental knee replacement (UKR) procedures performed for medial compartment knee arthritis from January 2001 to January 2010. The cohort participants were selected after stringent inclusion criteria and the average follow-up was 5.6 years (range 2–10 years). The fixed-bearing UKR procedure was carried out on all patients. The pre-operative mean knee range of movement improved from 100° ± 11.3° to 118.3° ± 12° (p value <0.001). The pre-operative mean Knee Society (KS) knee and functional score improved from 47 ± 5.5 and 55.1 ± 4.6 to 91.8 ± 9.2 and 92 ± 10.1 (p value <0.001), respectively. The revision rate of the cohort was 4 % (seven knees) and implant survival rate was 96 % at the end of 10 years; 87 % of the cohort were satisfied with the procedure and had a normal gait pattern. In this study, there was no statistical difference between groups with a body mass index (BMI) ≤30 kg/m2 and those with a BMI ≥30 kg/m2, and between groups aged ≤55 years and those aged ≥55 years, in clinical and functional outcome following UKR. This study confirms that fixed-bearing UKR gives excellent results in patients with medial compartment knee arthritis who comply with the inclusion criteria. Age and BMI were not considered to influence the clinical and functional outcomes. Level of evidence-III.

The aim of this study was to compare the intraosseous concentrations and the inhibitory effects on the growth of Staphylococcus aureus of 1 g versus 2 g of intravenous (IV) prophylactic cefazolin in total knee arthroplasty (TKA). Eighteen patients (21 knees) with primary knee osteoarthritis were divided into two groups receiving 1 g (12 patients: 14 knees) versus 2 g (six patients: seven knees) IV prophylactic cefazolin prior to the incision in TKA. Subchondral bone samples (proximal tibia, distal femur) were taken during the operation. These samples were analyzed for intraosseous concentration of cefazolin and their inhibitory effects on the growth of S. aureus, using high-performance liquid chromatography (HPLC) and agar disc diffusion bioassays. The mean intraosseous concentration in the 2 g dose group was significantly higher than in the 1 g dose group in the proximal tibia (p = 0.007) and distal femur (p = 0.016). There were no significant differences between the two groups in terms of mean inhibitory effects in the proximal tibia or distal femur (p > 0.05). No significant correlations were found between the intraosseous concentrations and inhibitory effects in the proximal tibia (r = 0.18, p = 0.52) and distal femur (r = −0.29, p = 0.30). IV cefazolin at a dose of 2 g produced greater intraosseous concentrations overall than a dose of 1 g. However, the higher intraosseous concentrations did not correlate with higher inhibitory effects. Level III.

High tibial osteotomy (HTO) is a surgical procedure used to change the mechanical weight-bearing axis and alter the loads carried through the knee. Conventional indications for HTO are medial compartment osteoarthritis and varus malalignment of the knee causing pain and dysfunction. Traditionally, knee instability associated with varus thrust has been considered a contraindication. However, today the indications include patients with chronic ligament deficiencies and malalignment, because an HTO procedure can change not only the coronal but also the sagittal plane of the knee. The sagittal plane has generally been ignored in HTO literature, but its modification has a significant impact on biomechanics and joint stability. Indeed, decreased posterior tibial slope causes posterior tibia translation and helps the anterior cruciate ligament (ACL)-deficient knee. Vice versa, increased tibial slope causes anterior tibia translation and helps the posterior cruciate ligament (PCL)-deficient knee. A review of literature shows that soft tissue procedures alone are often unsatisfactory for chronic posterior instability if alignment is not corrected. Since limb alignment is the most important factor to consider in lower limb reconstructive surgery, diagnosis and treatment of limb malalignment should not be ignored in management of chronic ligamentous instabilities. This paper reviews the effects of chronic posterior instability and tibial slope alteration on knee and soft tissues, in addition to planning and surgical technique for chronic posterior and posterolateral instability with HTO.

The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure. Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated. Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p  < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p  <  0.001), NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p  <  0.001). A statistically significant reduction of operated limb thigh circumference compared to the contralateral side (3.7%) was also found, while there were no statistical differences regarding the strength of gluteus maximus muscles. Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined. IV: retrospective comparative trial.