Level IV. Historical series.

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45-81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean followup was 34 (24-72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

Background and purpose Whether tibial torsion affects the positioning of extramedullary instrumentation and is a possible factor in malalignment of the tibial component in total knee arthroplasty (TKA) is unknown. We assessed the influence of tibial torsion on distal alignment of extramedullary systems for TKA, using the center of the intermalleolar distance as anatomical reference at the ankle joint.Patients and methods We analyzed CT scans of knee and ankle joints of 50 patients with knee osteoarthritis (mean age 73 years, 52 legs). The tibial mechanical axis was identified and translated anteriorly at the level of the medial one-third (proximal AP axis 1), at the medial border of the tibial tuberosity (proximal AP axis 2), and at the level of the talar dome (distal AP axis). The center of the intermalleolar distance and the width of the medial and lateral malleolus were calculated. The proximal AP axes 1 and 2 were translated at the level of the ankle joint and any difference between their alignment and the distal AP axis was calculated as angular and linear values.Results The center of the ankle joint was located, on average 2 mm medial to that of the intermalleolar distance. The distal AP axis was externally rotated by 18° and 27° compared to the proximal AP axes 1 and 2, respectively. Overall, the center of the ankle joint was shifted laterally by 9–11 mm with respect to the proximal AP tibial axes.Interpretation To avoid a varus tibial cut in TKA, extramedullary alignment systems should be aligned more medially at the ankle joint than previously thought, due to the effect of tibial torsion and—to a lesser extent—to the different malleolar width.

BackgroundThe relevance of prosthetic component orientation to prevent dislocation and impingement following total hip arthroplasty (THA) has been widely accepted. We investigated the use of a non-computer-based surgery to address the reciprocal orientation of the acetabular and femoral components.MethodsIn the femur first technique, the cup is positioned relative to the stem. When the definitive antetorsion of femoral component is fixed, the cup is positioned in a compliant anteversion to the stem. Clinical and radiographic assessments were performed before and 3 months after THA. Radiographic assessment was performed in standing position with the EOS 2D/3D radiography system. 3D images were used to preoperative anterior pelvic plane (APP) angle, postoperative acetabular inclination (AI) and anteversion (AA), and postoperative stem antetorsion. Clinical assessment was performed with Harris Hip Score (HHS).ResultsForty patients (40 hips) underwent primary THA with an average age of 61 years (range, 36–84). Average HHS increased from 43 ± 5 (range, 37–52) preoperatively to 97 ± 6 (range, 86–100) at the last follow-up (P < 0.0001). Average combined anteversion value of cup with liner and stem was 38° ± 9° (range, 12°-55°). Average AI value of cup with liner was 39° ± 6° (range, 30°-55°) in the group with standard stem and 45° ± 7° (range, 39°-58°) in the group with varized stem (P = 0.007). Relationship analysis showed no correlation between the combined anteversion values of the cup with liner and stem with APP angle values (r = 0.26, P = 0.87).ConclusionsFemur first technique allows the surgeon to achieve a combined anteversion ranging from 25° to 50° with a cup inclination ranging from 30° to 50°. The cup is positioned according to the functional plane of the patient regardless the preoperative pelvic tilt.

THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.

IntroductionTo evaluate the impact of short cementless stem on several clinical and radiographic outcomes, with particular focus on blood loss, in comparison with conventional cementless stem in total hip arthroplasty (THA). Materials and methodsPatients undergoing THA with GTS short stem or CLS conventional stem were included. Clinical data were retrospectively collected including preoperative and postoperative day 1 value for haemoglobin (HB); rate of postoperative blood transfusions; intraoperative bone infractions; stem alignment; 5-year follow-up Harris Hip Score (HHS) and rate of stem revision at 5 years of followup of the short and conventional cementless stem. ResultsGTS and CLS stem group included 374 and 321 patients, respectively. The mean difference between the preoperative and postoperative day 1 HB value was 3.98 g/dL (SD 1.12) and 3.67 g/dL (SD 1.19) in the GTS and CLS group, respectively, which correspond to a crude effect (β) of 0.32 (95% CI 0.15; 0.49) and adjusted effect of 0.11 (95% CI − 0.08; 0.3). GTS group reported a significantly higher number of patients with excellent results in terms of HHS (p = 0.001). The rate of intraoperative bone infractions was 1.6% and 0.3% in the GTS and CLS group, respectively (p = 0.013). At radiographic assessment, the rate of varus position of the stem was 14% in the GTS group and 6% in the CLS group (p < 0.0001). The rate of stem revision at 5 years of follow-up was 0.8% and 0.4% in the GTS and CLS group, respectively (p = 0.63). ConclusionsGTS short stem was not associated with a clinically significant lower blood loss in the immediately postoperative period. Unadjusted exploratory analyses show that GTS stem provides the same results of CLS stem in terms of HHS and rate of stem revision at 5 years of follow-up.

As changes of e r y t h r o c y t e g l u t a t h i o n e metabolism i s a s e n s i t i v e index o f the i n v i v o o x i d a t i v e processes, reduced glutnLhione ICSHI , o x i d i z e d g l u t a t h i o n e / CSSC/ s t a b i l i t y od CSH and o x i d a t i o n 3 t a t e o f haemoglobin have been measured. Data$ hd 11 c h i l d r e w i t h acute c e l i a s disease/ ACS/ 11 chlldt.en on g l u t e n f r e e d i e t / CFCD / were compared t o those o f 11 c h i l d r e n w i t h n u t r i t i v e i r o n d e t i c i e n c y /N l D l and Lo 11 h e a l t h y c h i l d r e n .IS c o n t r o l s . E r y t h r o c y t e CSH contcnL o f ACD qroup elevated s i g n i f i c a n t l y , t h e CSSC l e v e l decreased compared t o nornlal c o n t r o l s CSSC and CSSCICSH r a t i o n a l s o d i f f e r e d from those o f NID group, and a marked d i f f e r e n c e haa been measured i n g l u t a t h i o n e s t a b i l i t y , too. I n ACD group methaenloglobin and haenlicrom were measured. Anomalies o f e r y t h r o c y t e metabolism normaliaed d u r i n g t h e d i e t period. The decreased CSSC/ CSH value o f ACD group r e f e r s t o decreased a r t i v i t y o f seleoocnzym gluathione peroxidase, a s > g n i f i c a n t selenium d e f i c i e n c y /228-t158nq/gHb/ has been proved t o normal c o n t r o l s 14655 136ng/qHb/.Our r e s u l t s suggesL t h a t d u r i n g g l u t e n challenge ACO p a t i e n t s s u f f e r from c h r o n i c oxidant s t r e s s which p a r t i a l l y can be explained by the weakness o f scavanger system and by seleniunl d e f i c i e n c y . AREA UNDER pH 12Yvan Vandenplas, Anita Goossens, Mia Marichal. Academic C h i l d r e n ' s H o s p i t a l Free U n i v e r s i t y of B r u s s e l s . 2 4 Hour esophageal pH monitoring has become t h e p r e f e r r e d t e s t t o q u a n t i f y a c i d gastro-esophageal r e f l u x . Agreement has been achieved t h a t r e f l u x e d a c i d g a s t r i c c o n t e n t i n t o t h e esophagus c o n s t i t u t c s a major cause of r e f l u x e s o p h a g i t i s . Ke t h e r c f o r e c a l c u l a t e d t h e a s a r e a uneer pH 4" (A) i n 5 6 0 consecutive pfl monit i n i n f a n t s 1-12 months o l d , and r e l a t e d t h i s parameter t o t h e % time with pf1<4 ( r e f l u x i nd e x , R I ) : R I < 1 0 % : A 1 8 5 + / -2 9 5 (mean +/-1 SD); RI 1 0 -1 9 8 : A 1 0 4 6 + / -1206; RI 2 0 -2 9 8 : A 1 9 6 7 + / -2 0 3 8 ; RI 3 0 -3 9 % : A 3 3 0 7 + / -2 9 5 5 ; R I > 4 0 % : A 7 9 7 7 + / -7 2 2 7 . The "P." i s r e l a t k d t o t h e RI whereas according t o t h e I11 t h e "A" i n c r e a s e s s i g n i f i c a n t l y ( p < 0 . 0 0 1 ) ; t h e high SD, however, o b t a i n e d i n each group i l l u s t r a t e s t h e Great v a r i a b i l i t y i n 'A" ( o r a c i d i t y o f t h e r e f l u x e p i s o d e s ) i n a l l groups. Esoghagoscopy (and biopsy) was performed i n 1 1 2 i n f a n t s ( 2 0 % ) . S p e c i f i c i t y i n t h e p r e d i c t i o n of e s o p h a g i t i s was h i g h e r f o r t h e "A" ( 8 8 ...

Purpose: In total hip arthroplasty (THA), the functional anatomy of the spinopelvic unit should be taken into account to provide the correct functional positioning of the implant. The relationship between the spine and the pelvis in the sagittal plane is represented by pelvic tilt (PT). The sacral slope (SS) has been proposed as a more reliable parameter than the anterior pelvic plane (APP) to express the PT. This study investigated the relationship between the APP and the SS; and the relationship between the APP and the SS, respectively, with the postoperative acetabular orientation. Methods: 45 patients undergoing primary THA were prospectively enrolled. The EOS 2D/3D system was used to perform the radiographic evaluation before and 3 months after surgery. The following parameters were measured in both standing and sitting position: SS, APP, acetabular anteversion (AA) and inclination (AI). Results: The SS values did not show any correlation with the values of the APP angle. The changes of the SS in the transition from the standing to the sitting position significantly correlated with the changes of the AA ( r = −0.61; p < 0.0001). A weak correlation was found between the APP angle and the AA in standing position ( r = −0.35; p = 0.02). Conclusions: The SS accurately expresses the functional orientation of the pelvis in the sagittal plane, and the functional orientation of the cup after hip replacement. Therefore, SS could be taken into account by navigation systems in order to achieve a patient-specific functional position of the acetabular cup.