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We aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft. This prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years. Both IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee. Posterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee. Prospective case series (Level of evidence IV).

Osteoporosis-related hip fractures are associated with high mortality and costs. The optimum type of treatment for such fractures is controversial. To shed some light on this issue, the surgical treatment and management of osteoporotic hip fractures were discussed during a hip fracture surgical working group at the 2009 International Society For Fracture Repair Annual Meeting comprising leading experts in the field. The working group consisted of eight orthopaedic surgeons, six industry representatives and one research scientist. Eleven participants were from Europe and four were from the USA and Canada. Two chairmen posed 12 questions relating to the surgical treatment and management of osteoporotic hip fractures. Each question was discussed and key points were noted. Surgery should commence within 24–48 h but the patient should be optimized if presenting with ≥3 comorbidities. Specialized centres integrating orthopaedics, geriatricians and rheumatologists could be a solution for the lack of specialist care post-surgery. Surgical technique is important in fracture fixation, as is the implant, but there has been no improvement in implant design in the past 50 years. As a consequence, malunion has become unjustifiably accepted. Fracture healing can be accelerated using pharmaceuticals which are also important in secondary prophylaxis. All displaced femoral neck fractures in geriatric patients should be treated with hip replacement, the choice between using cemented or uncemented fixation being at the surgeon’s discretion. This working group discussion highlighted several important issues which could be of interest to the orthopaedic community.

Introduction: Undisplaced intracapsular fractures are predominantly treated with a minimally invasive fixation technique, whereas the standard treatment for displaced intracapsular fractures is still a subject of discussion. The purpose of this study was to identify the determinants influencing the outcome of intracapsular femoral neck fractures, treated with two cannulated hip screws. Patients and methods: From January 1998 through December 2002 data of all consecutive patients with an intracapsular femoral fracture, treated with two cannulated screws, were documented. Consolidation was chosen as the primary endpoint, mortality and a reoperation for replacement of osteosynthesis were defined secondary endpoints. Results: One hundred and twelve patients were included in the study. Fifty six percent of the intracapsular fractures healed within 1 year. Consolidation was accomplished in 95% of the stable fractures. Consolidation rates were negatively influenced by unstable fractures and inadequate anatomical reduction. The position of the screws did not influence consolidation rates. Reintervention rates were related to the number of local complications and the fracture type. Conclusion: In conclusion, the results of this study show that in case of operative treatment, undisplaced femoral neck fractures can be adequately fixated by two cannulated hip screws. Unstable, anatomically reduced femoral neck fracture (Garden III/IV) may be treated with a more stable implant (e.g. DHS) to avoid redisplacement. If adequate reduction cannot be achieved, endoprosthetic replacement is recommended.

Hip and knee arthroplasties are frequently complicated by the need for allogeneic blood transfusions. This survey was conducted to assess the current use of perioperative blood-saving measures and to compare it with prior results. All departments of orthopaedic surgery at Dutch hospitals were sent a follow-up survey on perioperative blood-saving measures, and data were compared to the results of two surveys conducted 5 and 10 years earlier. The response rate was 94 out of 108 departments (87 %). Most departments used erythropoietin prior to hip and knee replacements at the expense of preoperative autologous blood donation. The use of intraoperative autologous retransfusion in revision hip (56 vs. 54 %) as well as revision knee arthroplasty (26 vs. 24 %), was virtually unchanged. Postoperative autologous retransfusion is still used by the majority of departments after both primary arthroplasty and revision of hip (58/53 %) and knee (65/61 %). Currently, just as in 2007, the majority of Dutch orthopaedic departments uses erythropoietin, normothermia and postoperative autologous retransfusion with hip and knee arthroplasty. Intraoperative retransfusion is used mainly with hip revision arthroplasty. Other effective blood management modalities such as tranexamic acid have not been widely implemented.

Mặc dù metallosis là một biến chứng đã biết sau phẫu thuật thay khớp háng toàn phần, nhưng ít thông tin được biết đến về hiện tượng này sau phẫu thuật thay khớp gối toàn phần (TKA) hoặc thay khớp gối một phần (UKA). Mục tiêu của công trình này là xem xét kiến thức hiện tại về các nguyên nhân cũng như quản lý chẩn đoán và điều trị metallosis sau phẫu thuật thay khớp gối. Một tìm kiếm tài liệu đã được thực hiện thông qua PubMed đến tháng 4 năm 2019. Các từ khóa tìm kiếm bao gồm "metallosis" kết hợp với "khớp gối", "cắm khớp gối", "phẫu thuật thay khớp gối" và "thay khớp gối", tương ứng. Tất cả các ấn phẩm đã được phân tích về năm xuất bản, mức độ chứng cứ, số lượng khớp/khoá khám chữa, loại cắm, nguyên nhân metallosis, khoảng thời gian giữa việc cắm ban đầu và sự xuất hiện của metallosis, các xét nghiệm trong phòng thí nghiệm, điều trị, biến chứng và theo dõi. Tổng cộng có 38 nghiên cứu báo cáo về 97 khớp gối đã được xác định. 29 nghiên cứu báo cáo về metallosis sau TKA, 8 sau UKA, và một nghiên cứu về cả hai phương pháp. Khoảng thời gian giữa cắm ban đầu và sự xuất hiện của metallosis từ 6 tuần đến 26 năm. Nguyên nhân phổ biến nhất là sự thất bại của một thành phần đệm patellar dựa vào kim loại trong 40%, tiếp theo là sự thất bại của cắm/ cấu trúc và sự thất bại của PE (mòn/đi lệch) lần lượt ở mức 27% và 18%. Số lượng tế bào máu toàn phần, hóa sinh huyết thanh, tốc độ lắng của hồng cầu hoặc giá trị protein C-reactive trong huyết thanh không có tác dụng chỉ định để chẩn đoán metallosis. Chẩn đoán đã được xác nhận thông qua phân tích histopathological và đánh giá đại thể trong quá trình phẫu thuật. Tùy thuộc vào nguyên nhân cụ thể, nhiều thủ thuật phẫu thuật khác nhau đã được thực hiện. Thay thế hoàn toàn prosthesis là phương pháp phổ biến nhất với không có biến chứng trong 89,4% các trường hợp. Metallosis sau phẫu thuật thay khớp gối là một biến chứng hiếm và có thể bị đánh giá thấp hoặc ít được công bố. Một phương pháp chẩn đoán hệ thống là cần thiết để chẩn đoán kịp thời và chính xác. Việc làm sạch tỉ mỉ cũng như synovectomy (một phần) toàn phần nên luôn được thực hiện. Trong các trường hợp có thành phần bị hư hỏng, thay thế một phần/hoàn toàn prosthesis dẫn đến kết quả tốt nhất. Nếu sự không căn chỉnh là nguyên nhân gây ra metallosis, thì nó cần được chỉnh sửa trong quá trình phẫu thuật sửa đổi.

The meniscotibial ligament (MTL) limits extrusion of the medial meniscus (MM). While meniscal extrusion may be detrimental to knee joint biomechanics, the role of the MTL in meniscal extrusion is debatable. We sought to perform a systematic review and meta-analysis to evaluate the role of the MTL and surgical techniques for MTL repair. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines we searched PubMed, Cochrane Library, and Embase for: ((“Meniscotibial”) OR (“Coronary”) OR (“Ramp”)) AND (“Extrusion”). After screening and applying eligibility criteria, data were extracted for MTL pathology types (“traumatic” ruptures or “induced” injuries) and meniscal extrusion. A meta-analysis evaluated the mean difference of extrusion between “intact” MTLs (native or repaired) and “injured” MTLs (induced or traumatic). We further performed a subgroup analysis between traumatic and induced MTL lesions. This systematic review included six studies, which all evaluated MM extrusion. There were 74 knees with induced MTL injuries and 19 knees with traumatic MTL ruptures. Study designs were heterogenic and utilized three types of MTL repair procedures. The meta-analysis included 18 human knees and revealed that sectioning the MTL created a 2.92 mm [− 0.18 to 6.03] MM extrusion, while MTL repair decreased MM extrusion by − 2.11 mm [− 3.03 to − 1.21]. MTL injury may result in approximately 3 mm of MM extrusion, while repair of the MTL can decrease extrusion by 2 mm. Several novel surgical techniques exist to repair the MTL. However, studies reporting clinical outcomes of these various procedures are scarce.