Morsi Khashan

Superior outcome of strut allograft-augmented plate fixation for the treatment of periprosthetic fractures around a stable femoral stem

PURPOSE This study was designed to compare the outcome of two surgical approaches for treating femoral periprosthetic fractures around a stable femoral stem. The hypothesis was that plate fixation alone might be associated with a higher complication rate due to insufficient mechanical stability. We also considered that the addition of a strut allograft would contribute to fracture healing by means of osteoconduction. METHODS We retrospectively assessed the outcome of 21 patients who sustained periprosthetic fractures around a total hip replacement system (Vancouver type B1 and type C fractures) and who were treated in our department (January 2006 and August 2011) either by plate fixation alone or by plate fixation and a strut allograft. The mean postoperative follow-up was 23 months (range 9-69 months). Eleven patients were treated by plate fixation alone (Plate Group), and 10 patients were treated by plate fixation and a deep frozen cortical strut allograft (AG Group). Functional outcome was rated by the Harris Hip scoring system. Postoperative radiographs were assessed for evidence of fracture union. Surgical failure was defined as any complication requiring surgical revision. RESULTS The 21 patients included 17 females and 4 males. The average age was 79 years (range, 73-88) for the Plate Group and 82 years (range, 53-94) for the AG Group, and the average time to fracture union was 12 weeks (range, 2.5-6 months) and 12.95 weeks (range, 1.5-3) respectively. The overall failure rate was significantly higher in the Plate Group: 5 of them required revision surgery compared to none in the AG Group (p=0.014). CONCLUSION The results of this analysis indicate that a strut allograft augmentation approach to Vancouver type B1 and type C periprosthetic fractures results in a better outcome than plate fixation alone by apparently adding mechanical stability and enhancing the biological healing process.

Arthroscopic rotator interval closure in shoulder instability repair: A retrospective study

BACKGROUND Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shoulder instability. Young age, hyperlaxity, loss of bone stock and multidirectional or voluntary type of instability are all associated with failure of this procedure. Rotator interval laxity is associated with shoulder instability, whereas rotator interval closure increases humeral head stability and reduces shoulder range of motion. METHODS The records of patients with recurrent anterior shoulder dislocations who underwent ABR with or without arthroscopic rotator interval closure (ARIC) in our department between 1999 and 2007 were reviewed. Rates of recurrent dislocation or symptomatic subluxation as well as functional outcome were evaluated using Walch-Dupley score. RESULTS Three (8.1%) of the 37 ABR+ARIC patients (age 19-44 years, 32 males) had re-dislocated their shoulder at 42±16 months following the procedure, all of which had systemic joint hyperlaxity. Six (13%) of the 46 ABR patients (age 19-39 years, 42 males) had re-dislocated their shoulder at 13±14 months, three of which had systemic joint hyperlaxity and dislocated their shoulder within 1 year following the operation. Systemic joint hyperlaxity (28% of ABR and 41% of ABR+ARIC patients) was significantly associated with recurrent dislocation and poor functional outcome. ABR+ARIC patients had slightly more limited range of motion with similar good and excellent functional results (75%) at final follow up time. CONCLUSIONS Systemic joint hyperlaxity is a risk factor for failure of ABR. When ARIC is performed in combination with ABR, it may have an additive effect on shoulder stability.

Minimally Invasive Spinal Decompression in Patients Older Than 75 Years of Age: Perioperative Risks, Complications, and Clinical Outcomes Compared with Patients Younger Than 45 Years of Age

OBJECTIVE Minimally invasive spinal decompression for the treatment of spinal stenosis or disk herniation is often indicated if conservative management fails. However, the influence of old age on the risk of postoperative complications and clinical outcome is not well understood. We therefore sought to compare complication rates and outcomes after minimally invasive surgery decompression and discectomy in elderly patients with a cohort of younger patients undergoing similar procedures. METHODS We evaluated medical records of 61 patients older than 75 years and 69 patients younger than 45 years that underwent minimally invasive lumbar decompression between April 2009 and July 2013 at our institute. Medical history, American Society of Anesthesiologists score, perioperative mortality, complications, and revision surgery rates were analyzed. Patient outcomes included visual analog scale and EuroQol-5 Dimension scores. RESULTS The average age was 78.66 ± 4.42 years in the elderly group and 33.59 ± 6.7 years in the younger group. No major postoperative complications were recorded in either group, and all recruited patients were still alive at the time of the last follow-up. No statistically significant difference existed in the surgical revision rate between the groups. Both groups showed significant improvement in their outcome scores after surgery. CONCLUSIONS Our results indicate that minimally invasive decompressive surgery is a safe and effective treatment for elderly patients and does not pose an increased risk of complications. Future prospective studies are necessary to validate the specific advantages of the minimally invasive techniques in the elderly population.

Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures – A randomized controlled trial

AIM To compare the functional and radiographic results of dynamic hip screw (DHS) and expandable proximal femoral nail (EPFN) in the treatment of extracapsular hip fractures. METHODS A randomized controlled trial of sixty hip fracture patients. Outcomes included mortality, residency, independence, mobility, function and radiographic results at a minimum of 1 year. RESULTS Twenty-nine EPFN patients demonstrated fewer cases of shaft medialization or femoral offset shortening compared to the 31 DHS patients. Mortality, complications and functional outcomes were similar. CONCLUSION EPFN provides stable fixation of pertrochanteric hip fractures and prevents neck shortening that is commonly observed after DHS fixation.

Perceptions of orthopaedic surgeons regarding arthroscopic surgery for osteoarthritis of the knee - an international survey

Background:Osteoarthritis is one of the most common diseases of the joints in adults and a major contributor to functional impairment and reduced independence. Current treatment strategies include physical, pharmacological, and various surgical therapies. Knee arthroscopy is one such treatment that is frequently performed despite considerable evidence that suggests it provides no relevant therapeutic benefit. Methods:To examine current practice patterns, a survey was conducted among 279 orthopaedic surgeons from 57 countries regarding their use of knee arthroscopy for knee osteoarthritis. Surgeons’ preferences were stratified by country of origin, field of specialty, number of years of experience, and status. Results:The vast majority of orthopaedic surgeons surveyed would not perform knee arthroscopy for knee osteoarthritis (73%). Among the remaining 27%, this technique was more often preferred by surgeons practicing in Europe and other parts of the world (29.8%) compared with North America (15.6%) (P=0.02), regardless of seniority or field of subspecialty. Conclusions:Although controversy exists regarding arthroscopic treatment of knee osteoarthritis, it is still preferred by more than one-quarter of orthopaedic surgeons surveyed worldwide; a significantly greater proportion of those surgeons practice outside North America.

Lateral epicondylitis treatment: international survey of surgeons' preferences and literature review.

Lateral epicondylitis (LE) is a common cause of elbow pain. Despite a relatively high prevalence and morbidity, there is still no single effective (‘gold standard’) treatment for LE. We hypothesised that a surgeons experience, country of origin and area of expertise would influence choices concerning patient management. The purpose of this survey was to describe the current trends and common practices in treating LE worldwide.

Do orthopaedic surgeons resurface the patella

Background:Total knee replacement (TKR) is one of the most common and successful surgical procedures worldwide. There is no consensus among surgeons regarding the need for patellar resurfacing during TKR. Patellar resurfacing can result in lower reoperation rates while forgoing this procedure results in a shorter operation time and elimination of complications such as avascular necrosis and patellar fracture. Methods:Two hundred and seventy-nine orthopaedic surgeons of 10 subspecialties from 57 countries were surveyed as to their preferences regarding patellar resurfacing during TKR. Preferences were analyzed according to country of origin, field of expertise, and seniority and were compared with published data. Results:The survey response rate was 95%. Surgeons were split between resurfacing the patella (45%) and not resurfacing it (55%). North American surgeons favor patellar resurfacing more often than European surgeons (94% compared with 24%, P<0.0001) and surgeons from other countries (94% compared with 47%, P=0.01). Conclusions:The present study found no consensus among orthopaedic surgeons regarding patellar resurfacing during TKR. Patellar replacement is practiced more often by North American surgeons than by surgeons in other parts of the world.

Orthopaedic surgeons prefer new expensive technology for treatment of hip fractures: an international survey on the surgical practices

Background:The health care expenditures for the management of hip fractures are growing along with the rise in their prevalence. The ideal method of surgical treatment for hip fractures is controversial. The present survey aimed to determine the current international practices of the management of these fractures and to compare the findings with the available evidence. Methods:We distributed questionnaires to orthopaedic surgeons at the Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS) 2011 and the 12th meeting of the European Federation of National Associations of Orthopaedics and Traumatology (EFFORT). The following questions were asked: (1) In a displaced intracapsular hip fracture in an elderly patient, what is your treatment of choice? (2) In 31A1 and 31A2 hip fractures, what is your preferable implant for fixation? Results:The total number of responders was 291 from 57 countries. For the first question, 47% of the responders chose bipolar arthroplasty, 32% unipolar, 14% total hip replacement, and 7% open reduction internal fixation. For the second question 51% chose dynamic hip screw, 46% preferred an intramedullary device, and 3% chose other treatment modality. For both questions these choices were not influenced significantly by geographic origin, area of specialty, or the seniority status (P=0.25). Conclusions:While the common practice in the surgical treatment choice for intracapsular fracture of the elderly is not evidence based, the surgeons’ preferences are consistent with available evidence in the choice of surgical treatment for extracapsular hip fractures. The popularity of intramedullary devices for intertrochanteric fractures and bipolar hemiarthroplasties for intracapsular fractures is unjustified in light of their high relative costs.