To date, the literature has not yet revealed superiority of Minimally Invasive (MI) approaches over conventional techniques. We performed a systematic review to determine whether minimally invasive approaches are superior to conventional approaches in total hip arthroplasty for (1) clinical and (2) functional outcomes. We performed a meta-analysis of level 1 evidence to determine whether (3) minimally invasive approaches are superior to conventional approaches for clinical outcomes. All studies comparing MI approaches to conventional approaches were eligible for analysis. The PRISMA guidelines were adhered to throughout this study. Registries were searched using the following MeSH terms: ‘minimally invasive’, ‘muscle-sparing’, ‘THA’, ‘THR’, ‘hip arthroplasty’ and ‘hip replacement’. Locations searched included PubMed, the Cochrane Library, ClinicalTrials.gov, the EU clinical trials register and the International Clinical Trials Registry Platform (World Health Organisation). Twenty studies were identified. There were 1,282 MI THAs and 1,351 conventional THAs performed. (1). There was no difference between MI and conventional approaches for all clinical outcomes of relevance including all-cause revision (p=0.959), aseptic revision (p=0.894), instability (p=0.894), infection (p=0.669) and periprosthetic fracture (p=0.940). (2). There was also no difference in functional outcome at early or intermediate follow-up between the two groups (p=0.38). (3). In level I studies exclusively, random-effects meta-analysis demonstrated no difference in the rate of aseptic revision (p=0.461) between both groups. Intermuscular MI approaches are equivalent to conventional THA approaches when considering all-cause revision, aseptic revision, infection, dislocation, fracture rates and functional outcomes. Meta-analysis of level 1 evidence supports this claim

This technique is a novel superior based muscle sparing approach. Acetabular reaming in all hip approaches requires femoral retraction. This technique is performed through a hole in the lateral femoral cortex without the need to retract the femur. A 5 mm hole is drilled in the lateral femur using a jig attached to the broach handle, similar to a femoral nail. Specialised instruments have been developed, including a broach with a hole going through it at the angle of the neck of the prosthesis, to allow the rotation of the reaming rod whilst protecting the femur. A special C-arm is used to push on the reaming basket. The angle of the acetabulum is directly related to the position of the broach inside the femoral canal and the position of the leg. A specialised instrument allows changing of offset and length without dislocating the hip during trialling. Some instrumentation has been used in surgery but ongoing cadaver work is being performed for proof of concept. The ability to ream through the femur has been proven during surgery. The potential risk to the bone has been assessed using finite analysis as minimal. The stress levels for any diameter maintained within a safety factor >4 compared to the ultimate tensile strength of cortical bone. The described technique allows for transfemoral acetabular reaming without retraction of the femur. It is minimally invasive and simple, requiring minimal assistance. We are incorporating use with a universal robot system as well as developing an electromagnetic navigation system. Assessment of the accuracy of these significantly cheaper systems is ongoing but promising. This approach is as minimally invasive as is possible, safe, requires minimal assistance and has a number of other potential advantages with addition of other new navigation and simple robotic attachments

Hallux valgus surgery can result in moderate to severe post-operative pain requiring the use of narcotic medication. The percutaneous distal metatarsal osteotomy is a minimally invasive approach which offers many advantages including minimal scarring, immediate weight bearing and decreased post-operative pain. The goal of this study is to determine whether the use of narcotics can be eliminated using an approach combining multimodal analgesia, ankle block anesthesia and a minimally invasive surgical approach. Following ethics board approval, a total of 160 ambulatory patients between the ages of 18-70 with BMI ≤ 40 undergoing percutaneous hallux valgus surgery are to be recruited and randomized into Narcotic-free (NF) or Standard (S) groups. To date, 72 patients have been recruited (38 NF and 34 S). The NF group received acetaminophen, naproxen, pregabalin 75mg and 100mg Ralivia (tramadol extended release) before surgery and acetaminophen, naproxen, pregabalin 150mg one dose and Ralivia 100mg BID for five days, as well as a rescue narcotic (hydromorphone, 1mg pills) after surgery. The S group received acetaminophen and naproxen prior to surgery and acetaminophen, naproxen and hydromorphone (1mg pills) post-operatively, our current standard. Visual analog scales (VAS) were used to assess pain and narcotic consumption was recorded at 6, 12, 24, 36, 48, 72 hours and seven days post-operatively. Patients wore a smart watch to record the number of daily steps and sleep hours. A two-sided t-test was used to compare the VAS scores and narcotic consumption. During the first post-operative week, the NF group consumed in total an average of 6.5 pills while the S group consumed in total an average of 16 pills and this difference was statistically significant (p-value=0.001). Importantly, 19 patients (50%) in the NF group and four patients (12%) in the S group did not consume any narcotics post-operatively. For the VAS scores at 24, 48, 72 hours and seven days the NF group's average scores were 2.17, 3.17, 2.92, 2.06 respectively and the S group's average scores were 3.97, 4.2, 3.23, 1.97. There was a statistically significant difference between the groups at 24 and 48hours (the NF group scored lower on the VAS) with a p-value of 0.0008 and 0.04 respectively, but this difference is not considered clinically significant as the minimal clinically important difference reported in the literature is a two-point differential. The NF group walked an average of 1985.75 steps/day and slept an average of 8h01 minute/night, while the S group walked an average of 1898.26 steps/day and slept an average of 8h26 minutes/night in the first post-operative week. Hallux valgus remains a common orthopedic foot problem for which surgical treatment results in moderate to severe post-operative pain. This study demonstrates that with the use of multimodal analgesia, ultrasound guided ankle blocks and a percutaneous surgical technique, narcotic requirements decreased post-operatively. The use of long-acting tramadol further decreased the need for narcotic consumption. Despite decreased use of narcotics, this combined novel approach to hallux valgus surgery allows for early mobilization and excellent pain control

Patient Specific Instruments (PSIs) are becoming increasingly common in arthroplasty but have only been used with highly invasive surgical approaches that can result in significant complications. We have previously described a novel PSI for minimally invasive total shoulder arthroplasty and shown that it can accurately guide the creation of guide holes in the humerus and scapula. However, conducting shoulder replacement in a minimally invasive environment precludes the use of traditional instruments. In this work, we describe and evaluate the efficacy of a set of novel instruments that, in conjunction with our PSIs, enable accurate minimally invasive total shoulder arthroplasty to be achieved for the first time. The key components of this surgical procedure are: 1) a new minimally invasive posterior surgical approach that avoids the need for muscle transection; 2) a novel PSI that enables accurate guide tunnels to be simultaneously created in the humerus and scapula using a c- shaped drill guide that mates to the PSI; 3) a custom humeral head resection guide that uses the humeral guide tunnel; 4) a novel reamer and 3D metal printed gear mechanism for radial displaced drilling both powered by a central driver placed through the humeral head; and 5) custom impactors for glenoid and humeral implantation – the latter is achieved using a modular slap hammer that is guided by the central humeral drill hole. Accuracy of this system was assessed at each surgical step using an optical tracking camera and an iterative closest point registration method to map measurements to the pre-operative plan. The accuracy results for the physical PSI registration and guide hole drilling were found to be in line with our previously reported results: the intra-articular guide hole locations were 2.2mm and 3.9mm for the humerus and glenoid with angular errors of 2.8° and 8°, respectively. After humeral resection, the humeral cut plane had an angular error of 10.1°. The final humeral implant location had an error of 12.1° and 1.9mm. For the glenoid implant, the positional error was 3.8mm with angular errors of 3.3° ante-retroversion and 8.6° supero- inferior inclination. We believe that these initial results demonstrate that this minimally invasive PSI and instrumentation system can accurately guide total shoulder replacement while avoiding the complications of open surgery. A full cadaveric testing series is currently being completed

Abstract. Background. Anterior cruciate ligament (ACL) injuries with coinciding posterolateral tibial plateau (PLTP) depression fractures are rare. According to the most up to date literature, addressing the PLTP is crucial in preventing failure of the ACL. However, the surgical management of these injuries pose a great challenge to orthopaedic surgeons, given the anatomical location of the depressed PTP fragment. We report a case of a 17-year-old patient presenting to our department with this injury and describe a novel fixation method, that has not been described in the literature. Surgical Technique. A standard 2-portal arthroscopy is used to visualise the fractures. The PLTP is addressed first. With the combined use of arthroscopy and fluoroscopy, a guide pin is triangulated from the anteromedial aspect of the tibia, towards the depressed plateau fragment. Once the guide pin is approximately 1cm from the centre of the fragment, it is over-drilled with a cannulated drill, and simultaneously bluntly punched up to its original anatomical location. Bone graft is then used to fill the void, supported by two subchondral screws. Both fluoroscopy and arthroscopy are used to confirm adequacy of fixation. Finally, the tibial spine avulsion fracture is repaired arthroscopically using the standard suture bridging technique. Conclusion. We describe a novel, one-stage, minimally invasive approach that addresses both the ACL injury and PLTP fracture. We highlight the advantages of utilising this approach and functional outcomes

Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of complications in primary joint replacement. The purpose of this study was to compare patient outcomes and complication rates between obese and non-obese patients undergoing primary total hip arthroplasty (THA) through a Bikini direct anterior incision. This retrospective, single surgeon study compared the outcome of 258 obese patients and 200 non-obese patients undergoing DAA THA using a Bikini incision, over a 7-year period. The average follow-up was 4.2 years (range 2.6-7.6 years). There were no statistically significant differences in the complication rate between the two groups. The obese group recorded 2 major (venous thromboembolism and peri-prosthetic fracture) and 2 minor complications (superficial wound infection), compared with the non-obese group, which recorded 2 major (deep-wound infection and peri-prosthetic fracture) and 1 minor complication (superficial wound infection). Patient-reported outcomes (WOMAC and Harris Hip Scores) showed significant post-operative improvements (p < 0.001) and did not differ between the two groups. Bikini DDA THA does not increase the complication rate in obese patients and offers similar clinical improvements compared to non-obese patients. (200 words)

Abstract. Background. We know that tears of the Triangular fibrocartilage complex (TFCC) can cause DRUJ instability and ulnar sided wrist pain. This study shows the clinical result of patients who had arthroscopic transosseous repair of the TFCC tear with DRUJ instability. Arthroscopic repair of TFCC tear is a promising, minimally invasive surgical technique especially in patients with DRUJ instability. Materials and methods. Fifteen patients who underwent TFCC one tunnel repair form 2018–2021 were reviewed retrospectively in hospital. The proximal component of TFCC was repaired through arthroscopic one- tunnel transosseous suture technique. VAS score for pain, wrist range of motion, grip strength and post operative complications were evaluated and each patient was rated according to the DASH score. Results. The patients had a TFCC tear confirmed on MRI and was confirmed on arthroscopy by doing a hook test. The patients were followed up for 6 months. Twelve patients had normal stability of DRUJ and three patients showed mild laxity compared with the contralateral side. The mean VAS score reduced from 4.7 to 0.8 (P=0.001) and grip strength increased significantly. The quick DASH score (P=0.001)also showed significant functional improvement. No surgical related complications occurred. Conclusions. Arthroscopic one tunnel transosseous TFCC foveal repair can be an excellent and safe method for repair of TFCC tear with DRUJ instability. Its a good treatment option in terms of reliable pain relief, functional improvement and reestablishment of DRUJ stability

Percutaneous flexor tenotomy involves cutting the flexor digitorum tendons to correct claw toe deformity to treat apical pressure areas and prevent subsequent infection in patients with peripheral neuropathy. Performing this under ultrasound guidance provides reassurance of complete release of the tendon and increases procedural safety. This study is a retrospective case series evaluating the effectiveness, safety, and patient satisfaction of performing percutaneous ultrasound-guided flexor tenotomy in an outpatient setting. People with loss of protective sensation, a digital flexion deformity, and an apical toe ulcer or pre-ulcerative lesion who presented to our institution between December 2019 and June 2022 were included in this study. Participants were followed-up at a minimum of 3 months. Time to ulcer healing, re-ulceration rate, patient satisfaction, and complications were recorded. An Australian cost analysis was performed comparing this procedure performed in rooms versus theatres. There were 28 ulcers and 41 pre-ulcerative lesions. A total of 69 tenotomy procedures were performed on 38 patients across 52 episodes of care. The mean time to ulcer healing was 22.5 +/- 6.4 days. There were 2 cases of re-ulceration. 1 patient sustained a transfer lesion. There were four toes that went onto require amputation, all in the setting of pre-existing osteomyelitis. 94% of patients strongly agreed that they were satisfied with the outcome of the procedure. Costs saved were estimated to be $1426. Flexor tenotomy is a minimally invasive procedure that can be performed in the outpatient setting, and therefore without delay to treatment, reducing risk of ulcer progression and need for subsequent amputation. This is the first study to report on flexor tenotomy under ultrasound-guidance. Ultrasound-guided percutaneous flexor tenotomy is safe and effective, with high patient satisfaction and low recurrence rates. This performance in the outpatient setting ensures significant time and cost savings for both the practitioner and patient

The Femoral Neck System (FNS) was introduced as an alternative device for the fixation of neck of femur fractures (NOFFs). The purported advantages include superior angular and rotatory stability compared to multiple cancellous screws, via a minimally invasive instrumentation that is simpler than conventional fixed angle devices. There were limited clinical studies regarding the utility of this device. We aimed to study the outcomes of NOFFs fixed with the FNS. This was a single-institution, retrospective review of all undisplaced elderly (≥60 years old) undisplaced young, and displaced young NOFFs fixed with the FNS. Demographics, surgical parameters, radiographic parameters, and clinical outcomes including complications were reviewed. Thirty-six subjects with a median age of 75 [44,89] years old, had NOFF fixation using the FNS. Thirty-one (86.1%) had undisplaced fractures. There were 6 (16.7%), 26 (72.2%), and 4 (11.1%) subjects with Pauwels types 1, 2, and 3 respectively. Thirty-two (88.9%) had posterior tilt of <20º. The mean duration of surgery was 71±18 minutes. Excluding 4 patients whom required revision surgery, 2 patients whom demised, and 10 patients whom defaulted reviews, the mean follow-up duration was 55±13 weeks. Four complications were recorded, namely implant cut out at the femoral head at week 8, breaking of the locking screw at the run-off region at week 22, avascular necrosis at week 25, and a refracture following near fall, causing the fracture to fail in varus at week 7 postoperation. While reasonably fast to instrument, failures still occur and it is likely multifactorial. However, the rate of reoperation is lower than what has been reported for NOFFs fixed with the a fixed-angle device or 3 cancellous screws. In conclusion, the FNS is a reasonably safe instrument to use. Surgeons’ discretion is still needed in patient selection, keeping in mind the need for satisfactory radiological parameters

Postoperative surgical site infection in patients treated with lumbosacral fusion has been believed to be caused by perioperative contamination (Perioperative Inside-Out infections) in patients with comorbidities. With the proximity of these incisions to the perianal region and limited patient mobility in the early post-operative period, local contamination from gastrointestinal and/or urogenital flora (Postoperative Outside-In infections) should be considered as a major source of complication. A single center, retrospective review of adult patients treated with open posterior lumbosacral fusions between January 2014 and January 2021. We aimed to identify common factors in patients experiencing deep postoperative infections. Oncological, minimally invasive, primary infection, and index procedures carried out at other institutions were excluded. We identified 489 eligible patients, 20 of which required debridement deep to the fascia (4.1%). Mean age (62.9 vs 60.8), operative time (420 vs 390 minutes), estimated blood loss (1772 vs 1790 mL) and median levels fused (8.5 vs 9) were similar between the infected and non-infected groups. There was a higher percentage of deformity patients (75% vs 29%) and increased BMI (32.7 vs 28.4) in the infected group. The mean time from primary procedure to debridement was 40.8 days. Four patients showed no growth on culture. Three showed Staphylococcus species (Perioperative Inside-Out infections) requiring debridement at a mean of 100.3 days (95%CI 0- 225 days). Thirteen patients showed infection with intestinal or urogenital pathogens (Postoperative Outside-In infections) requiring debridement at a mean of 20.0 days (95%CI 9-31 days). Postoperative Outside-In infections led to debridement 80.3 days earlier than Perioperative Inside-Out infections (p= 0.007). In this series, 65% of deep infections were due to early local contamination by gastrointestinal and/or urogenital tracts pathogens. These infections were debrided significantly earlier than the Staphylococcus species infections. Due to the proximity of the incisions to the perianal region, there should be increased focus on post-operative local wound management to ensure these pathogens are away from the wound during the critical stages of wound healing

Background. In this study, we investigated the long-term clinical results and survivorship of minimally invasive unicompartmental knee arthroplasty (UKA) by collecting cases that have been implanted for >10 years ago. Methods. Medial UKA on 180 cases in 142 patients was performed over a period of 1 year after the first introduction of minimally invasive UKA from January 2002 to December 2002. Among these, 166 cases in 128 patients who underwent Oxford phase 3 medial UKA using the minimally invasive surgery, with the exclusion of 14 cases including 10 cases of follow-up loss and 4 cases of death, were selected as the subject. The mean age of the patients at the time of surgery was 61 years, and the duration of the follow-up was minimum 10 years. All the preoperative diagnosis was osteoarthritis of the knee joint. Clinical and radiographic assessments were measured by the Knee Society clinical rating system, and the survival analysis was confirmed by the Kaplan–Meier method with 95% confidence interval (CI). Results. The mean Knee Society knee and function scores improved significantly from 53.8 points (25 to 70) and 56.1 points (35 to 80) preoperatively to 85.4 points (58 to100) and 80.5 points (50 to 100) at 10-year follow-up, respectively(P<0.001). The mean range of the motion of the knee joint recovered from 128.6° (110° to 135°) to 132.5o (105o to 135o) (P<0.001), and the tibiofemoral angle changed from the mean 0.2° of varus (7o of varus to 7o of valgus) to 4.6° of valgus (2° of varus to 11° of valgus) under the weight-bearing X-ray (P<0.001). Failures following the UKA occurred in 16 cases in 14 patients out of a total of 166 cases (9.6%), and the mean time of the occurrence of the failure was 6.2 years after the surgery. The causes of the failure included 7 cases of simple dislocation of mobile bearing, 4 cases of loosening of implant, 1 case of dislocation of mobile bearing accompanied by loosening of implant, and 1 case of dislocation of mobile bearing accompanied by the rupture of the medial collateral ligament (MCL). Moreover, there was 1 case of fracture of polyethylene bearing, 1 case of deep infection and 1 case of failure because of medial tibial condylar fracture. Of the total of 16 cases of failures, 11 cases (69%) were treated with revision total knee arthroplasty (TKA), whereas 5 cases (31%) were treated with a simple change of mobile bearing. The 10-year survival rate was 90.5% (95% CI, 85.9 to 95.0) when failure was defined as all the reoperations, whereas the 10-year survival rate was 93.4% (95% CI, 89.6 to 97.1) when the cases in which only revision TKA was defined as failure. Conclusions. The results of this study show outstanding functions of the knee joint and satisfactory 10-year survival rate after minimally invasive UKA. Therefore, minimally invasive UKA could be a useful method in the treatment of osteoarthritis in one compartment of knee joint

Background. Exebacase, an antistaphylococcal lysin in Phase 3 of development as a treatment for S. aureus bacteremia/right-sided endocarditis has demonstrated antibiofilm activity in vitro and has previously been used as salvage therapy in four patients with relapsing multidrug-resistant (MDR) S. epidermidis knee prosthetic joint infection (PJI) using a procedure called LysinDAIR (administration of the lysin during the performance of an arthroscopic DAIR). Materials/methods. We performed a single center, exploratory, open-label prospective study using the LysinDAIR procedure in patients with chronic (inoculation >3 months prior to treatment) coagulase-negative staphylococci (CNS) PJI of the knee with two different clinical presentations and treatment paradigms. Cohort A: first episode of CNS knee PJI, for whom the LysinDAIR was followed by clindamycin + levofloxacin planned to be prescribed for three months and then stopped; and Cohort B: relapsing episodes of MDR CNS knee PJI for whom the LysinDAIR was followed by primary antimicrobial therapy for three months, followed by suppressive antimicrobial therapy (SAT). Exebacae susceptibility testing was performed before treatment for each patient. In agreement with the French Health authority, exebacase (2 to 3.5 total mg in 30–50 ml (∼0.067 – 0.075 mg/m) was administered directly into the joint during arthroscopy. Results. Eight patients were treated. Exebacase administration was well tolerated by all patients and no serious adverse drug reactions to exebacase were reported. In cohort A (n=4), patients had susceptible S. epidermidis PJI, a painful joint effusion without fistula and without loosening, and received three months of levofloxacin + clindamycin (one patient received an alternative regimen following antibiotic adverse events) and then antibiotics were stopped. During a follow-up of 14, 19, 26 and 36 months, no relapse, no recurrence of the joint effusion and no loosening occurred. In cohort B (n=4), patients had MDR CNS, clinical signs of septic arthritis with a joint effusion without fistula and without loosening and received daptomycin + linezolid or doxycycline. One patient died from COVID-19 at week 4. SAT (tedizolide, n=2; doxycycline, n=1) was then prescribed to other patients. One experienced an infection relapse involving S. caprae under tedizolid therapy at six months. The two other patients continue to do well under SAT 8 and 12 months after the LysinDAIR procedure. Conclusions. The LysinDAIR procedure is a minimally invasive procedure, which has been shown to be easy-to-perform, safe, and has the potential for use as initial treatment or salvage therapy in patients with CNS chronic knee PJI

Introduction. “Bioexpandable” prostheses after resection of malignant bone tumors in children to lengthen the bone using the method of callus distraction may offer new perspectives and better long-term results. Materials and Methods. The bioexpandable prosthesis is equipped with an encapsulated electromotor which enables the device to perform distraction in an osteotomy gap with about 1mm/day. The new bone is improving the ratio from bone to prosthesis and therewith the potential stability of the final stem. The device is indicated, when limb length discrepancy is getting more than 3 cm or at maturity and can be used in a minimal invasive way for femur lengthening. Results. 11 patients were treated with the bioexpandable prosthesis. The mean age of the patients was 13,5 years and the mean amount of lengthening was 74mm. In 2 cases lengthening was performed in 2 steps and in 1 case in 3 steps. All lengthening procedures could be finished without complications. There was no infection and no technical problem. The bone regenerate in one tibia case was poor so that bone grafting from the iliac crest was necessary. Conclusions. The “bioexpandable” prosthesis is a new concept for limb lengthening after tumor resection in children. The latest patented version of the prosthesis under development allows all lengthening manoeuvres and the placement of the final stem via small incisions not only for the femur but also for the tibia

Introduction. Hip dysplasia is the most common congenital deformity of the musculoskeletal system. This is a pathology that brings the hip joint from subluxation to dislocation. Frequency of hip dysplasia − 16 children per 1000 newborns. Materials and Methods. Diagnostic methods of research are X-ray inspection which is necessarily carried out at internal rotation (rotation) of an extremity as lateral rotation of a hip on the radiograph always increases an angle of a valgus deviation of a neck. Surgical treatment is performed in the subclavian area of the femur. An external fixation device is applied and a corrective corticotomy is performed, and valgus deformity and anteversion are eliminated. The duration of treatment is 2.5–3 months. Results. Frequency of hip dysplasia − 16 children per 1000 newborns. We perform about 30 operations a year, including 60% girls and 40% boys. In addition, valgus deformity can be traced -. - in cerebral palsy. - after polio. - at progressing muscular dystrophies. - tumor in the area of the epiphyseal cartilage. At insufficient stability in a hip joint at insufficiently expressed roof of an acetabulum of rotational deformation of a neck of a hip, for prevention of a coxarthrosis and normalization of a ratio of articular ends operation detorsion-varying subvertebral corticotomy of a femur is shown. Conclusions. The operation is minimally invasive, with accesses of 5–6 mm, anatomical and topographical features are taken into account, which will eliminate damage to tissues, nerve trunks and the circulatory system

Introduction. Fully implantable systems are used commonly only after maturity. What are indications to use fully implantable systems at the femur even in children?. Materials and Methods. Implantable lengthening nails (FITBONE) were used retrograde at the femur in minimal invasive technique to correct a limb length discrepancy of >6 cm. In 5 cases a relevant deformity was corrected in the same surgery. In all cases a final step of lengthening was planned at the femur and at the tibia with fully implantable devices at maturity. Results. 18 patients with the medium age of 10,3 years (8–14) were treated. In 17 cases the goal of lengthening was achieved without any complication. In one case of proximal femoral deficiency lengthening had to be stopped because of increasing tendency of knee joint luxation. Bone formation occurred circular around the nail in all cases. Full load bearing was possible in the average after 2,2 days/mm. No technical problems occur. In one case induced deformity in the lateral plane was observed which was corrected at the final step. At the end of treatment functional and cosmetical result was perfect in all cases. Conclusions. Fully implantable motorized distraction nails are a favorable option for lengthening and deformity correction of the femur even for children older than 10 years to correct limb length discrepancy of more than 6 cm. The treatment has a low pain level, is comfortable and nearly no scars are visible

Abstract. Background. Scaphoid non-union can result in pain, altered wrist kinematics leading to a Scaphoid Non-union Advance Collapse, ultimately to symptomatic radio-carpal arthritis. Open techniques have their limitations. We describe the rationale, surgical technique and outcomes of our series of arthroscopic bone-grafting (ABG) and fixation of scaphoid non-union. Methods. We performed a prospective single-surgeon series of 22 consecutive patients with clinico-radiologically established scaphoid non-union between March 2015 and April 2019. Data was collected from Electronic Patient Records, Patient Archived Computer system (PACS) and hand therapy assessments. We collected demographic data including age, hand-dominance, occupation and mechanism of injury. The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH), Mayo wrist score, Patient Rated Wrist Evaluation (PRWE) and grip-strength measurements were collected preoperatively and at follow-up appointments. Results. There was an improvement in all outcome measures when comparing preoperative and postoperative results. The Quick DASH score improved by a mean of 24 points, Mayo wrist and PRWE scores improved by 15.1 and 29.7 points, respectively. Grip-strength analysis also improved by 6.1 kgf (Right) and 3.3kgf (Left). Follow-up computerised tomography scans revealed union in 18/22 patients with 2 patients lost to follow-up. One patient required revision ABG procedure to achieve union. Conclusion. Arthroscopic bone grafting and fixation of scaphoid non-union allows a minimally invasive method of managing these injuries. It has advantages of minimal morbidity and accurate articular reduction resulting in less postoperative stiffness and increased functional outcomes. It is an effective alternative to conventional open treatment of established scaphoid non-union

Purpose. Minimally invasive anterolateral approach (ALA) for total hip arthroplasty (THA) has gained popularity in recent years as better postoperative functional recovery and lower risk of postoperative dislocation are claimed. However, difficulties for femur exposure and intraoperative complications during femoral canal preparation and component placement have been reported. This study analyzes the anatomical factors likely to be related with intraoperative complications and the difficulties of access noted by the surgeons through a modified minimally invasive ALA. The aim is to define the profile for patient at risk of intraoperative complications during minimally invasive ALA. Methods. We retrospectively included 310 consecutive patients (100 males, 210 females) who had primary unilateral THA using the same technique in all cases. The approach was performed between the tensor fascia lata and the gluteus medius and minimus, without incising or detaching muscles and tendons. Posterior translation was combined to external rotation for proximal femur exposure (Fig. 1). All patients were reviewed clinically and radiologically. For the radiological evaluation, all patients underwent pre- and postoperative standing and sitting full-body EOS acquisitions. Pelvic [Sacral slope, Pelvic incidence (PI), Anterior pelvic plane angle] and femoral parameters were measured preoperatively. We assessed all intraoperative and postoperative complications for femoral preparation and implantation. Intraoperative complications included the femoral fractures and difficulties for femoral exposure (limitations for exposure and lateralization of the proximal femur). The patients were divided into two groups: patients with or without intraoperative complications. Results. Ten patients (3.2%) had intraoperative femoral fractures (greater trochanter: 2 cases, calcar: 8 cases). Five fractures required additional wiring. Difficult access to proximal femur was reported in the operative records for 10 other patients (3.2%). There was no difference in diagnosis, age, sex, BMI between the patients with or without intraoperative complications. No significant group differences were found for surgical time, and blood loss. Patients with intraoperative complication, presented a significantly lower pelvic incidence than patients without intraoperative complications (mean PI: 39.4° vs 56.9°, p<0.001). The relative risk of intraoperative complications in patients with low PI (PI<45°) was more than thirteen times (relative risk; 13.3, 95% CI= 8.2 to 21.5. p<0.001) the risk for patients with normal and high PI (PI>45°). Conclusions. Anterolateral approach for THA implantation in lateral decubitus is reported to have anatomical and functional advantages. Nevertheless, the exposure of the femur remains a limitation. This study highlights a significant increased risk in case of low PI less than 45°. This specific anatomical pattern reduces the local working space as the possibility for posterior translation and elevation of the proximal femur is less on a narrow pelvis. This limitation is due to the length and the orientation of the hip abductor and short external rotator muscles related to the relative positions of iliac wing and greater trochanter (Fig. 2). This study points out the importance of pelvic incidence for the detection of anatomically less favourable patients for THA implantation using ALA. For any figures or tables, please contact the authors directly

Backgrounds. The authors present an analysis of 30 cases of total hip prosthesis performed with minimally invasive surgical earlier compares with 30 cases of total hip prosthesis performed surgically with direct side. The intent is to demonstrate the immediate and clear advantages especially in the postoperative surgical minimally invasive front. Methods. The authors present a randomized study of thirty cases of patients undergoing surgery for osteoarthritis of the hip prosthesis with primary surgical minimally invasive front compared to a group of 30 patients undergoing surgery with direct surgical side. All patients had the same cementless implants and instruments with the same surgeon. Patients were then evaluated in four different times: before surgery, immediate postoperative, after 1 week and 4 months after surgery. Results and conclusions. The experience of the authors on the surgical front shows the immediate and clear advantages in postoperative species by saving the muscle tissues, little pain, little bleeding, more quick and easy re-education and rehabilitation

INTRODUCTION. Computer-aided systems have been developed recently in order to improve the precision of implantation of a total knee replacement (TKR). Several authors demonstrated that the accuracy of implantation of an unicompartmental knee replacement (UKR) was also improved. Minimal invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation. The benefits of minimal-incision surgery might include less surgical dissection, less blood loss and pain, an earlier return to function, a smaller scar, and subsequently lower costs. However, there might be a concern about the potential of minimal invasive techniques for a loss of accuracy. Navigation might help to compensate for these difficulties. Mobile bearing prostheses have been developed to decrease the risk of polyethylene wear. The benefits might be a better survival and less bone loss during revisions. However, these prosthesis are technically more demanding, and involve the specific risk of bearing luxation. Again, navigation might help to compensate for these difficulties. MATERIAL AND METHODS. We wanted to combine the theoretical advantages of the three different techniques by developing a navigated, minimal invasive, mobile bearing unicompartmental knee prosthesis. 160 patients have been operated on at our institution with this system. The 81 patients with more than 2 year follow-up have been re-examined. Complications have been recorded. The clinical results have been analyzed according to the Knee Society Scoring System. The subjective results have been analyzed with the Oxford Knee Questionnaire. The accuracy of implantation has been analyzed on post-operative antero-posterior and lateral long leg X-rays. The 2-year survival rate has been calculated. RESULTS. We observed 8 complications related to the implant or the operative technique: 2 cases of meniscus instability (1 revision to TKR, 1 bearing exchange); 2 cases of tibia loosening (revised to TKR), 2 cases of femoral loosening (revised to TKR), 1 case of lateral disease progression (revised to TKR), 1 case of unexplained pain syndrome (revised to TKR). The mean Knee Score was 93 points, 44% had the maximum of 100 points, and only 10% have less than 85 points. The mean pain score was 48 points/50. The mean flexion angle was 128°, and 60% had at least 130° of knee flexion. The mean Function Score was 97 points, 84% have the maximum of 100 points, and only 5% had less than 85 points. The mean Oxford Knee Questionnaire score was 19 points (best result: 12 points, worst result: 60 points). Expected limb axis correction was obtained in 77% of the cases. 62% of the cases had an optimally implanted prosthesis for all studied criteria. The 2-year survival rate was 97%. DISCUSSION. Most of the revision cases were related to technical difficulties during the development phase. Fixation of the implant has been improved, and some imprecise steps of the software have been corrected. Since these changes occurred, no severe early complication related to implant or software has been observed. The current implant is considered reliable, and the current minimal invasive navigated technique is considered reliable as well

Introduction. Growing evidence in the literature suggests better clinical and functional outcomes and lower re-rupture rates with repair compared to non-operative treatment of ruptured Achilles tendon. There are however, concerns of wound infection, nerve injury and scar tenderness with the standard open and percutaneous techniques of repair. We aim to evaluate clinical and functional outcomes and complications in patients treated with minimally invasive Achillon device. Materials and Methods. Prospectively collected clinical data was reviewed of all consecutive patients who underwent repair of the ruptured Achilles tendon using the Achillon device. Patients were contacted using a postal questionnaire for assessment of their functional status using the validated Achilles Tendon Total Rupture Score (ATRS) and compared with their uninjured side. The outcomes were compared to the published results. Results. We present patient demographics; and clinical and functional outcomes of 140 consecutive patients who underwent repair of ruptured Achilles tendon using the minimally invasive technique between June 2007 to August 2010. Our complication rate was of two-three percent each of proximal DVT, scar sensitivity, superficial wound infection and no re-rupture after a minimum of 6 months. There was no case of nerve injury leading to permanent neurological deficit. Discussion. This study demonstrates good clinical and functional outcomes from using the Achillon device in repair of ruptured Achilles tendon with a low complication rate comparable to other published series. We recommend Achillon device as a safe minimally invasive technique for repair of the ruptured Achilles tendon