Background and purposeRecurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA).Patients and methodsWe analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons.ResultsPosterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5–0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5).InterpretationCompared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.
Over the last decade, there has been a concerning increase in the number of invasive meningococcal serotype W infections in Europe. Although sepsis and meningitis are the most feared complications, focal complications of systemic disease such as pneumonia, pericarditis and arthritis can also occur. We present a rare case of isolated meningococcal W135 arthritis of the hip without invasive meningococcal disease in a 6-year-old patient.
The Foot and Ankle Online Journal 2 (7): 3 A 39 year-old woman injured the big toe of her right foot after a fall down the stairs. Upon examination there was a dislocation of the hallux. A plain radiograph showed a dislocation of the interphalangeal joint of the hallux and interposition of a sesamoid bone in the articular space. An attempt at closed reduction was unsuccessful, after which open reduction and excision of the sesamoid was undertaken. Dislocation of the interphalangeal joint of the hallux with interposition of a sesamoid is a rare injury. It is almost always the result of a hyperextension trauma. The clinical appearance together with a plain radiograph is in most cases sufficient for the diagnosis. Closed reduction should be attempted before open reduction is undertaken. If this is unsuccessful, it is probably due to an invaginated volar plate and sesamoid. Open reduction and removal of the sesamoid is then required followed by reduction of the volar plate plantarward. In general, the recovery is complete and without problems.
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