Introduction and Objective. Interest for direct anterior approach (DAA) in hip hemiarthroplasty (HHA) has greatly increased in recent years, however which is the best surgical approach in hip replacement treating femoral neck fractures (FNFs) is already unclear. The aim of this study is to perform a radiographic and perioperative complications analysis by comparing the direct anterior approach (DAA) with the direct lateral approach (DLA) in patients treated with hemiarthroplasty for FNFs. Materials and Methods. Patients with FNFs surgically treated between 2016–2020 with HHA were enrolled. The radiographical outcomes of DAA and DLA are compared. Several peri-operative and post-operative variables were evaluated: mean surgery time, complications as periprosthetic fractures or episodes of dislocation, the average of post-operative diaphyseal filling of the stem (Canal Fill Index, CFI), the extent of heterotopic ossification (HO) (simplified Broker classification) and metadiaphiseal bone loss (Paprosky classification) within one year from surgery. Results. 86 patients underwent HHA by DAA and 80 patients by DLA. The two groups are qualitatively comparable. No statistically significate differences were showed in all variables analyzed (p>0.05). The average of surgical time of DAA were 61 minutes compared to 67 of DLA. No differences were showed in the post-operative CFI (DAA 0.71 ± 6.1; DLA 0.76 ± 13.5), the extent of the HO (DAA 79.07% low; DLA 75% low) and metadiaphiseal bone loss (DAA Grade I 91.86%; DLA Grade I 93.75%). Regarding perioperative complications, we have discovered only one periprosthetic fracture each group. Although there was no statistically significant difference, we highlighted a higher number of dislocations in the group of DLA (2 episodes vs no one). Conclusions. In this study we have shown that the DAA is an adequate surgical choice comparing with the classical DLA for FNFs treated with HHA. The analysis of our radiographic parameters and perioperative complications have not shown a significant difference between the two surgical approach. This study is limited by a purely radiographic analysis without addition of clinical parameters

Abstract. Objective. To compare the clinical and radiological outcome between less invasive stabilization system (LISS, Synthes, Paoli, PA.) and open reduction with internal fixation (ORIF) for the treatment of extraarticular proximal tibia fractures through the lateral approach. Background. Proximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. But these are associated with problems especially overlying skin conditions, delayed recovery and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods. Thirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into 2 groups. Group I (n=15) patients were treated by LISS and group II (n=15) by ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6 months. Results. In each group, 12 patients were united, 2 patients were non- united and one patient showed delayed union. The mean operative time in LISS patients was 79.3 min, while in ORIF patients; it was 122 min. All patients of LISS group were exposed to radiation, while only 40% of ORIF group were exposed. The mean time of union of LISS patients was 10.87weeks. While in ORIF patients, the mean time of union was 21.13 weeks. There was no significant difference between both groups regarding the postoperative complications. Functional outcome was satisfactory in both groups. Conclusion. LISS achieves comparable results with ORIF in extraarticular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Surgical microfracture is considered a first line treatment for talar osteochondral defects. Pain reduction, functional improvement and patient satisfaction are described to be 61–86% in both primary and secondary osteochondral defects. However, limited research is available whether improvement of the surgical technique is possible. We do know that the current rigid awls and drills limit the access to all locations in human joints and increase the risk of heat necrosis of bone. Application of a flexible water jet instrument to drill the microfracture holes can improve the reachability of the defect without inducing thermal damage. The aim of this study is to determine whether water jet drilling is a safe alternative compared to conventional microfracture awls by studying potential side effects and perioperative complications, as well as the quality of cartilage repair tissue in a caprine model. 6 mm diameter talar chondral defects were created bilaterally in 6 goats (12 samples). One defect in each goat was treated with microfracture holes created with conventional awls. The contralateral defect was treated with holes created with 5 second water jet bursts at a pressure of 50 MPa. The pressure was generated with a custom-made setup using an air compressor connected to a 300 litre accumulator that powered an air driven high-pressure pump (P160 Resato, Roden, The Netherlands, . www.resato.com. ). Postoperative complications were recorded. After 24 weeks, analyses were performed using the ICRS macroscopic score and the modified O'Driscoll histological score. Wilcoxon ranked sum tests were used to assess significant differences between the two instrument groups using each goat as its own control (p ≤ 0.05). One postoperative complication was signs of a prolonged wound healing with swelling and reluctance to weight bearing starting two days after surgery on the water jet side. Antibiotics were administered which resolved the symptoms. The median total ICRS score for the tali treated with water jets was 9,5 (range: 6–12) and 9 (range 2–11) for Observer 1 and 2 respectively; and for the tali treated conventionally this was 9,5 (range 5–11) and 9 range (2–10). The median total Modified O'Driscoll score for the tali treated with water jets was 15 (range: 7–17) and 13 (range: 3–20) for Observer 1 and 2 respectively; and for the tali treated conventionally was 13 (range: 11–21) and 15 (range: 9–20). No differences were found in complication rate or repair tissue quality between the two techniques. The results suggest that water jet drilling can be a safe alternative for conventional microfracture treatment. Future research and development will include the design of an arthroscopic prototype of the water jet drill. The focus will be on stability in nozzle positioning and minimized sterile saline consumption to further the decrease the risk of soft tissue damage

Summary Statement. This project proves that Patellofemoral (PF) joint degeneration is not a contraindication to medial unicompartmental knee replacement. Introduction. Unicompartmental knee arthroplasty (UKA) is a recognised procedure for treatment of medial compartment osteoarthritis. Patellofemoral (PF) joint degeneration is widely considered to be a contraindication to medial unicompartmental knee replacement. We examined the validity of this preconception using information gathered prospectively on consecutive patients who underwent UKA using the Repicci II® UKA prosthesis for medial compartment osteoarthritis. Methods. We prospectively collected data on 147 consecutive patients who underwent the Repicci II® UKA for medial compartment osteoarthritis. All operations were performed between July 1999 and September 2000 by the same surgeon. The status of the PF joint was assessed intra-operatively in all patients, and accordingly patients were divided into two groups, one group with a normal PF joint, and the second group with degenerative changes of the PF joint. Variables measured for outcome included the International Knee Society (IKS) score, limb alignment, and range of motion. Radiographs were assessed for progression of disease or failure of implant. The mean follow-up was 9.4 years (range: 5–10.7 years). Patients were reviewed initially at 2 weeks, and then at 6 months post-operatively. They were subsequently reviewed on an annual basis.. All patients completed an IKS score preoperatively and at last follow-up. Age, gender, BMI, length of hospital stay, perioperative complications, all subsequent surgery, including revision of the prosthesis, and survivorship at 10 years was recorded, and results of the 2 groups compared. Results. A total of 147 patients were included in the study. None were lost to follow-up. Sixty nine had associated PF osteoarthritis (group A) while 78 patients had a normal PF compartment when assessed intra-operatively (group B). Post-operative outcomes of the two groups were compared using the ANCOVA analysis with adjustment for pre-operation values firstly, and adjusting also for gender, age, BMI and follow-up secondly. There were no significant differences in terms of IKS, alignment, and flexion between the two groups. However, patients in group B had significantly better extension post-operatively than patients in group A (p<0.05). Conclusion. We concluded that damage to the articular cartilage of the patellofemoral joint to the extent of full-thickness cartilage loss is not a contraindication to the Repicci II® unicondylar knee arthroplasty for medial compartment osteoarthritis. However, extension is significantly improved post-operatively in those patients with minimal or no PF joint degenerative disease