Michele D'Arienzo

Wound drainages in total hip arthroplasty: to use or not to use? Review of the literature on current practice

Aim of this study is to analyze data reported in literature concerning the efficacy of using wound low-vacuum suction drainages in orthopedic surgery after total hip arthroplasty. We analyzed studies concerning the use of drainages in prosthetic hip replacement surgery, performing our research through Pubmed, Cochrane database and Google Scholar, and selecting the ones evaluating the following parameters: bleeding, the need for blood transfusions, number or reinforcement of post-operative medications, length of hospitalization, functional results, periprosthetic and surgical wound infection, post-operative hematoma. Our review did not show any demonstrated advantage from the use of wound drainages in total hip arthroplasty. Moreover, some studies enlighted a possible complication related to their employment, represented by the greater need for blood transfusions. Despite the absence of a statistically demonstrated positive influence on wound outcome using suction drains after total hip replacement, many orthopedic surgeons still recommend using drainages, just because there is no certified proof of a negative effect.

Posterior subtalar dislocation.

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.

Anterior dislocation in a total knee arthroplasty: A case report and literature review

Dislocations of a total knee arthroplasty (TKA) are an uncommon injury and only few cases of anterior dislocations have been reported. We report a rare case of anterior dislocation of a 10-year-old posterior stabilized total knee arthroplasty in a 74-year-old woman. The patient was successfully treated by close reduction of the dislocation followed by immobilization in full extension with a long leg cast. Because of a high risk of neurovascular complications, a high index of suspicion for vascular injury must be maintained. For this reason, a proper diagnosis is required and immediate reduction is recommended.

Femoro-acetabular impingement. Classification, diagnosis and treatment.

The success of a total hip arthoplasty is linked to a long survival, and this one is obtained reducing the surfaces wearing. Polyethylene material was introduced by Sir John Charnley in the 60’s and has been until now the cartilage most similar material regarding the Young modulus, despite metal and ceramic ones. It has been also characterized by a good wear, especially nowadays the highly cross-linked polyethylene technology has been developed. In the last years, research has been oriented to already used materials improvement such as metals and metal alloys (steel, titanium, CrCo, tantalum), to study and product dense and bioactive ceramics (alumina), to study and product polymeric and composite materials. The physical properties of some polymers have shown to be very similar to those of the normal cartilage. Considering that the most relevant impairment in an arthritic hip regard the articular cartilage, it’s easy to figure out the importance of regaining the cartilage function in anatomical THA surgery. Years of study and laboratory tests have led to the production of a new acetabulum module made of PCU (polycarbonate urethane), which would play a buffer/plug role, as the normal cartilage of a healthy hip does. The emerging buffer characteristics consist of the mentioned optimum modulus of elasticity which results moreover as a shock absorber, and the optimum microelastodynamic lubrication which reduce the friction coefficient. The buffer is presented as an acetabular cup to be inserted in a metal back (titanium coated CrCoMo) press-fit implanted. It can also be implanted directly in contact with the acetabular bone, previous the thin residual cartilage layer removal, allowing a more anatomical surgery and a bone stock sparing. PCU buffer is intended to be a new way of thinking total hip arthroplasty, nevertheless the acquired experience is actually confined among few Centers and further laboratory tests are going to be concluded. The path has drawn, it has just to be covered!