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ResumoApresentamos um caso único de um homem de 56 anos que deambulou com um espaçador cimentado para quadril durante 11 anos. Após ser submetido a uma hemiartroplastia em virtude de um acidente de carro, o paciente desenvolveu uma infecção articular periprotética (IAP) vários anos depois, sendo submetido à técnica de revisão da etapa 1. Com a resolução da infecção depois da etapa 1, o paciente recusou a segunda etapa, devido à satisfação com o espaçador cimentado por quase 11 anos.Pelo que sabemos, este é o caso mais longo relatado de um espaçador cimentado em um paciente deambulando. Este caso demonstra a confiabilidade mecânica dos espaçadores cimentados reforçados com metal que podem ser mantidos por um prazo longo em pacientes selecionados.

BackgroundThe type of anesthesia used in total knee arthroplasty is one modifiable factor that could save hospital systems time and money. With spinal and general anesthesia having similar outcomes, more weight can be placed on these anesthesia methods' time or money-saving aspects. ObjectiveThis study aims to determine the differences in time expenditure between spinal and general anesthesia for total knee arthroplasty to optimize OR efficiency and reduce costs. MethodsA retrospective analysis of 200 unilateral total knee arthroplasty procedures (CPT Code 27447) was performed from Jan 2017 -July 2019 at one institution. 100 of these received spinal anesthesia, and 100 received general anesthesia. Patient charts were reviewed to obtain demographic, surgical, and anesthetic data. ResultsTime to prepare the patient for surgery and total preoperative time was significantly decreased in the general anesthesia group (24.4 minutes vs. 18.5 minutes; p=<0.0001 and 25.4 minutes vs. 20.4 minutes; p=0.012). After surgery, the time to remove the patient from the operating room was significantly decreased in the spinal group (4.8 minutes vs. 7.0 minutes; p= <0.0001). Nonoperative total time was not significantly different between the two groups (49.3 minutes vs. 46.6 minutes; p=0.1127). ConclusionWhile there are significant differences in certain operating room time periods between spinal and general anesthesia, these differences are effectively canceled out when considering total operating room time.

Severe cases of acetabular fractures are complicated, leading to further damage to the femoral head and post-traumatic osteoarthritis (PTOA). These adverse events eventually lead to complexities in the management of patients with the aforementioned conditions. Total hip arthroplasty (THA) is a surgical option for improving both stability and functionality, and for controlling pain in patients with PTOA. Herein, we report the case of a 70-year-old male patient with neglected bilateral acetabular fracture who presented with PTOA and protrusion. Despite significant limb-length discrepancy with the deformity of both hips, the patient underwent a successful right THA and recovered with remarkable stability. One year later, the patient underwent successful left THA. One year following the surgical treatment, the patient is pain free with notable mobility. When treating a patient with a neglected acetabular fracture and bilateral PTOA, bilateral THA is a viable treatment option with favourable patient outcome.