Objective: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods: We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results: Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions: We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study.

ObjectiveTo evaluate the medium-term clinical–functional results (minimum follow-up of six years) from total uncemented hip arthroplasty performed by means of a posterior minimally invasive access, in comparison with the traditional right lateral access.MethodsIn a comparative prospective study, 224 adult patients underwent elective total hip arthroplasty due to a diagnosis of primary or secondary osteoarthrosis. A group of 103 patients with posterior minimally invasive access was compared with a group of 121 patients with the traditional right lateral access. The mean length of follow-up among the patients of this sample was 7.2 years. We evaluated the clinical–functional and radiographic results and occurrences of loosening, along with any complications that occurred, with a minimum follow-up of six years.ResultsThe clinical–functional analyses before the surgical procedure and six years afterwards were similar in the two groups (p = 0.88 and p = 0.55). One patient in the minimally invasive group underwent revision of the acetabular component and two patients in the control group underwent the same procedure (p = 0.46). The Trendelenburg clinical test, which showed weakness of the hip abductor musculature, was present in five patients operated using the traditional lateral route and absent in all those who underwent the minimally invasive procedure (p = 0.06). There was no difference regarding the radiographic parameters obtained, either in acetabular or in femoral positioning (p = 0.32 and p = 0.58).ConclusionsThe medium-term clinical and radiographic results and the complication rates were similar between the patients who underwent total hip arthroplasty by means of the posterior minimally invasive access and those with the traditional lateral access.

The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.

Background: The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI). Methods: Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI. Results: 54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture ( p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09–10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery ( p < 0.05). Conclusions: Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).

r e v b r a s o r t o p . 2 0 1 5;5 0(1):77-82 w w w . r b o . o r g . b r informações sobre o artigo Histórico do artigo: Recebido em 16 de outubro de 2013 Aceito em 20 de fevereiro de 2014 On-line em 28 de julho de 2014 Palavras-chave: Osteoartrite do quadril Artroplastia de quadril Procedimentos cirúrgicos minimamente invasivos r e s u m o Objetivo: Avaliar o resultado clínico-funcional em médio prazo (seguimento mínimo de seis anos) da artroplastia total do quadril não cimentada feita por acesso minimamente invasivo (MIS) posterior comparado ao acesso lateral direto (LD) tradicional. Métodos: Em um estudo comparativo prospectivo, 224 pacientes adultos foram submetidos à artroplastia total do quadril em caráter eletivo, por diagnóstico de osteoartrose primária ou secundária, e se comparou o grupo MIS posterior (103 pacientes) com o grupo acesso LD tradicional (121). A média de tempo de seguimento dos pacientes da amostra foi 7,2 anos. Avaliamos os resultados clínico-funcionais e radiográficos e a ocorrência de solturas, assim como complicaç ões ocorridas com um seguimento mínimo de seis anos. Resultados: A análise clínico-funcional antes e seis anos após o procedimento cirúrgico foi semelhante nos dois grupos (p = 0,88 e p = 0,55). Um paciente do grupo MIS foi submetido à revisão do componente acetabular e dois do grupo controle foram submetidos ao mesmo procedimento, p = 0,46. O teste clínico de Trendelenburg, que evidenciou uma fraqueza da musculatura abdutora do quadril, estava presente em cinco pacientes operados pela via lateral tradicional e ausente em todos os submetidos ao MIS (p = 0,06). Não houve diferença quanto aos parâmetros radiográficos obtidos tanto do posicionamento acetabular quanto do femoral (p = 0,32, p = 0,58).Conclusões: Os resultados em médio prazo, clínicos e radiográficos, e a taxa de complicaç ões foram semelhantes entre os pacientes submetidos à artroplastia total do quadril pelo acesso posterior minimamente invasivo e pela via lateral tradicional.