Purpose

Two-stage revision with the removal of all prosthesis has been considered to be the gold standard for treatment of periprosthetic joint infection. However, removal of well-fixed femoral stem is technically challenging and may cause excessive bone loss. The aim of this study was to compare the results between retention and removal of femoral stem when performing two-stage revision total hip arthroplasty for periprosthetic joint infection.

Purpose

The purpose of the present study was to compare functional outcomes of medial unicompartmental knee arthroplasty (UKA) in patients with lateral meniscal lesion (LM (+) group) in the preoperative MRI and those without lateral meniscal pathology (LM (−) group) and to evaluate the effect of lateral meniscus lesion in preoperative MR on functional outcomes after UKA.

Purpose

The purpose of this study was to evaluate the postoperative maximal flexion of Robotic assisted TKA which does not increase the posterior condylar offset after surgery and compare CT and conventional radiography in measuring the posterior condylar offset changes.

There exist 4 methods for femoral fixation of hip spacers:

a simple insertion,

To our knowledge, it is still unknown which of these methods provides the best stability.

Between 01.01.1999–31.12.2008, 84 hip spacer implantations in 78 patients have been performed in our department. All patients have been treated with the same kind of spacer. 24 spacers have been fixed with the “glove”-technique, 18 with a partial cementation onto the proximal femur, 21 with a simple insertion, and 4 with a cement bridge. In 17 cases with an isolated septic loosening of the acetabular cup, only a spacer head has been placed onto the well-fixed prosthesis stem.

The overall dislocation rate between stages was 21.4 % (18/84). The lowest dislocation rate was observed in the “spacer head” group with 5.8 % (1/17), followed by the “glove”-technique with 12.5 % of the cases (3/24). In the “partial cementation” group the dislocation rate was 22.2 % (4/18), whereas in the “insertion” group spacer dislocations occurred in 9 out of 21 cases (42.8 %). In the latter group, in 3 cases the spacer rotated primarily in the femur and dislocated subsequently out from the acetabulum. From the 4 patients having been treated with a cement bridge, 2 patients suffered from a spacer dislocation. From these 18 cases, 15 patients have been treated conservatively by reduction and immobilization in a hip orthesis during the remaining time between stages. The other three cases underwent further surgical procedures; in one case (combined spacer dislocation and -fracture), the spacer had been exchanged, whereas the other two cases had been treated by resection arthroplasty after recurrent spacer dislocations and unsuccessful conservative treatment.

The “glove”-technique seems to be the most effective method for femoral fixation fixation of hip spacers regarding the prevention of dislocations between stages. Further advantages of this technique include a safe and easy spacer explantation in one piece without cement debris at the second stage.

Background: The purpose of this study was to evaluate the results after hallux valgus surgery by transar-ticular adductor tenotomy, distal Chevron metatarsal osteotomy and Akin phalangeal osteotomy using medial one incision.

Materials and Methods: From June 2004 to June 2007, eighty feet of 54 patients were included in this study. During the same period, other cases of hallux valgus correction were excluded. Thirty seven patients underwent both feet operation at the same time and 17 patients underwent single foot operation. Among the 37 patients who underwent both feet operation, proximal metatarsal osteotomy was performed for contralateral 11 feet at same time, and these cases with proximal metatarsal osteotomy were excluded from this study. Postoperatively, all patients were allowed immediate full weight bearing walking. Patients were evaluated according to the American Orthopedic Foot and Ankle Society(AOFAS) hallux metatarsophalangeal-interpha-langeal scale, VAS(visual analogue scale), post-operative complications and radiologic parameters such as hallux valgus angle, intermetatarsal angle, T-test was used to evaluate the degree of hallux valgus and intermetatarsal angles. The mean follow up period was 25.9 months.

Results: At the last follow up, the mean AOFAS hallux metatarsophalangeal-interphalangeal scale increased from 48.7 to 91.9. The Mean VAS score decreased from 7.1 to 0.8 post-operatively. The mean hallux valgus angle of 31.4° (range, 22° to 46°) improved to 5.3 ° (range, 0° to 20°) after the operation. The mean intermetatarsal angle also showed improvement from 12.3° (range, 7° to 16°) to 5.5 ° (range, 2° to 11°). Comparison between preoperative and postoperative hallux valgus and intermetatarsal angles was done by T test in dependent groups, which showed statistical significance (p< 0.05). There were three cases of mild hallux varus and three cases of recurred valgus deormity. No avascular necrosis or union problem was observed on the radiographs in any of the patients.

Conclusion: Hallux valgus deformity correction by transarticular adductor tenotomy, distal Chevron metatarsal osteotomy and Akin phalangeal osteotomy using medial one incision has the advantages of lower morbidity and less scar without avascular necrosis of the metatarsal head.