Aims

Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol.

Purpose of the study: Stiffness of the ankle joint is a common complication after fracture, surgical repair, or total ankle arthroplasty. Dorsiflexion is generally the most limited movement. A few older papers have focused on this common problem in orthopaedic surgery of the ankle joint but have been controversial. The purpose of this anatomy study was to evaluate the efficacy and quantify the impact of releasing the collateral ligaments of the ankle joint on dorsiflexion stiffness.

Material and methods: The two main ankle ligaments implicated in this type of stiffness, the deep bundle of the posterior tibiotalar ligament (dPTTaL) and the posterior talofibular ligament (PTaFL), were studied. We dissected 16 talocrural joints on fresh cadavers and measured with electronic goniometry coupled with electronic dynamometry their movement in dorsiflexion after section of the dPTTaL in the first group and after section of the PTaFL in the second.

Results: The results showed a significant difference (p< 0.0003) between the two populations of ankles. Section of the dPTTaL was more effective against dorsiflexion stiffness than section of the PTaFL, even though the overall benefit in dorsiflexion was less than 10° (mean 7.45 versus 3.45). Combined section of the two ligaments did not provide a statistically significant improvement in the gain in dorsiflextion (p=0.88) compared with isolated section of the two ligaments.

Discussion: If limitation of active and passive dorsiflexion persists after classical release or lengthening of the posterior periarticular tendons of the ankle joint, or after gastrocnemius lengthening, our results show that the following surgical step could be meticulous release of the dPTTaL.

Purpose of the study: The purpose of this retrospective work was to analyse a series of ten patients (11 osteotomies) who underwent closed rotation osteotomy of the femur performed with an endomedullary saw and stabilized with a centromedullar locked nail. We identified the proper indications, technical aspects, clinical and radiological outcome and describe the complications of this surgical technique.

Material and method: The 11 osteotomies were performed in ten patients from January 1999 to July 2007 for post-trauma rotation defects or congenital deformity. On average the rotation defect was 33.5 (range 24–52), mainly internal rotation (10 cases versus 1 with external rotation). One female patient required a bilateral procedure in a context of congenital bilateral trochlea dysplasia. For two other patients the corrective osteotomy was associated with a lengthening procedure performed during the same operative time (totally closed operation). Clinical and radiological follow-up was available to 4 years 9 months on average (range 26–104 months). The angle corrections were determined on bone tomographs.

Results: Ten of the 11 osteotomies yielded correction to ±4° physiological values (or controlateral values if the other side was healthy) for anteversion of the femoral neck. There were no infections (bone, joint, skin, soft tissue) and not late healing or non-union. There was one transient neurological complication involving the pudendal nerve during a rotation-lengthening procedure and one bilateral fracture of the femur during a bilateral osteotomy. All patients healed within 3 to 5 months. Subjective outcome was satisfactory very satisfactory for 8 of 9 patients (one lost to follow-up) in terms of functional recovery and aesthetic aspect of the scars.

Discussion: The closed procedure for rotation osteotomy of the adult femur is a reliable, effective, safe and reproducible technique for the correction of rotation defects of the femur resulting from trauma or congenital disorders. These results can be obtained only with rigorous technique requiring experience and skill with centromedullary nailing.