Introduction: Deep infection continues to be the second most important early complication in hip arthroplasty. It is usual to apply standard prophylaxis to all patients, but it is not usual to use special measures in those of them who present a higher risk. Moreover, sometimes these patients are even not identified.

Purpose: To analyse statistically significant risk factors for deep infection in patients with a hip arthroplasty

Patients and Methods:

Design: Case-control study.

Observational and retrospective comparison of incidence or prevalence of all risk factors described in the literature. These factors have been classified according to the period of risk in: epidemiologic; pre, intra and postoperative; and distant infections.

Case series: 47 consecutive patients with a deeply infected hip arthroplasty operated in the same Department of a University General Hospital.

Control series: 200 randomly selected patients, operated in the same hospital and period of time, with no deep infection in their hip arthroplasty along follow-up.

Pearson was used for comparison of qualitative variables and ANOVA for quantitative ones.

Results: The following risk factors were significantly more frequent (p< 0.05) in the patients with an infected hip arthroplasty:

Epidemiologic characteristics: female gender, post-traumatic osteoarthritis (17% vs 3%). On the contrary, primary osteoarthritis is a “protective” factor.

Conclusion: To identify significative risk factors for deep infection in hip arthroplasty is important:

to control and minimize these risk factors when present

Introduction and purpose: The aim of this study is to determine the risk profile of a repeat hip fracture based on the patients’ intrinsic characteristics, their associated risk factors and concomitant pathological conditions, with the aim of carrying out preliminary work that might allow subsequent studies to quantify these risk factors.

Materials and methods: Case study and multi-center control: 1576 cases of hip fracture were collected of which 138 (8.76%) were repeat-fractures of the hip (the latter was the test group and the control group comprised the remaining 1574 cases [91.24%]). Variables were analyzed that could represent the risk profile of the patients and their predisposition to an osteoporotic fracture, their modifiable or non-modifiable risk factors and concomitant pathological conditions. Qualitative variables were analyzed using chi square; any necessary adjustments were made by means of Fischer’s exact test when necessary.

Results: The mean age of the control group was 82.45 ± 8.08 (36–102) and 83.26 ± 7.86 (53–100). The difference had no statistical significance (0.7 years). Of all the differences between the single fracture and repeat-fracture groups, the only one with statistical significance was the existence of a maternal history of fracture (p= 0.0034), which is a risk factor for contralateral hip fracture. The other variables studied did not achieve statistical significance independently of the trend seen.

Conclusion: In our series a maternal history of hip fracture is the only predictive factor of a repeat hip fracture.

Introduction: The Spaso technique for reduction of glenohumeral dislocation (GHD) has been recently introduced. It is considered to be a simple and successful method. However there are very few series. This study assesses the results obtained after the introduction of this technique in the Emergency Department.

Materials and methods: A prospective observational study was carried out in the Emergency Department in the Hospital Clínic of Barcelona from 15 January to 25 of March 2007, when the Spaso technique began to be used. There were 27 glenohumeral dislocations reported in 26 patients. Two cases that had more than one day’s evolution were excluded. The mean age of the patients was 51 years (range 22–80); and there were 14 men and 10 women. In most cases (18 of the 25) analgesic-sedative treatment was administered previously. Success or failure of reduction was recorded as well as all associated complications.

Results: The technique was effective in 19 of the 25 cases (76% rate of success). In relapses of gleno humeral dislocation, reduction was achieved in 8 out of 9 cases. The success rate was similar for residents and specialists. No complications were seen.

Conclusions: The results achieved allow us to consider the Spaso technique as the safest and most effective method for reduction of anterior glenohumeral dislocation, with success rates similar to those previously described. We consider that it is simple to learn and that it is one more technique to add to the resources available to the trauma specialist in the Emergency Department.

Introduction: The incidence of postoperative periprosthetic femoral fractures ranges from 0.1% in primary arthroplasty to 2.1% in revision surgery, and is often a challenge for the surgeon.

Materials and methods: We carried out a retrospective clinical study of periprosthetic femoral fractures found among the primary arthroplasties and revision hip replacements performed at San Carlos University Hospital between 1991 and 2003. We found 82 patients with postoperative periprosthetic femoral fractures. The fractures were classified according to the Vancouver classification, and we analysed the associated risk factors, treatments used, complications and results.

Results: The mean age of the patients was 72 (SD 12). There were 57 women (69.5%) and 25 men (30.5%). Of the 82 cases, 22 (26.8%) were type B1 fractures, 33 type B2 (40.2%), 20 type B3 (24.4%) and 7 type C (8.5%). The most common surgical treatment was the combination of a long stem held in place with cerclage wires in 27 cases (33%), followed by treatments using allografts in different combinations in 22 cases (26.8%).

Conclusions: Femoral bone stock is a factor that influences the occurrence of periprosthetic fractures.

The use of allografts has little effect on the fracture consolidation time, although it involves an increase of femoral bone stock, which makes allografts advisable even in Vancouver type B2 fractures.

Introduction and Objectives: This rare disease (17 per million newborns) was described by Chatelaine in 1882 and is more prevalent in females compared to males (2.3:1). It is commonly accompanied by congenital or genetic malformations. Within the syndrome known as genu recurvatum, congenital knee dislocation (CKD) is the most extreme clinical form. In view of the scarcity of trials and reviews on the subject of CKD and results of therapy for the same, we determined to gather clinical case data from the hospital from 01–01-1964 to 01–01-2003 and evaluate therapeutic, orthopaedic, and surgical experience.

Materials and Methods: Of 28,753 patients treated in the aforementioned period, 55 were treated for genu recurvatum. We selected 22 with unilateral or bilateral CKD. We individualised the cases of 14 patients with 20 knees as patients diagnosed and treated since birth by this centre, excluding those with multi-malformation genetic syndromes (Larsen’s syndrome, arthrogryposis, etc.). In terms of treatment, 13 knees were treated orthopaedically by means of successive manipulations and splinting until 90° of flexion was achieved. At that point, physical therapy was initiated. There were 7 other knees that received at least one surgical treatment when results of the previously-described orthopaedic procedures were unsatisfactory. The clinical outcome for the treatment method used in each case was assessed by means of evaluation of range of mobility of the knee joint, stability upon examination, residual deviation from the axes, and ability of the patient to walk at time of release.

Results: Of the 65% of knees that were treated exclusively by orthopaedic methods, we observed ranges of flexion and stability such that splinting was not needed at an average of 55.2 days, with good to excellent clinical outcomes at an average of 42.4 days. Of the 35% of knees that required at least one surgical procedure, the procedure was performed between the ages of 30 and 176 days of life, with a mean of 90.8 days. As many as 75% of these knees required repeated surgical intervention during the treatment period, and good to excellent results were achieved in only 35% by 5 years of age.

Discussion and Conclusions: Orthopaedic treatment continues to be the foundation of managing these patients, and plays a vital role even in cases were surgical intervention is chosen. The existence of other genetic or non-genetic developmental anomalies concurrent with CKD will determine the therapeutic strategy that is indicated and when such action should take place. We do not recommend surgical treatment except in cases of a continued lack of response to orthopaedic treatment.