Screwed cups and short stems in hip

Dr. Nikolaos Christodoulou  who is chairman of  Orthopedic Department in Orthopaedic Surgical Department in Iatriko Psychikou Clinic - Athens Medical Group (Greece). Being an invited keynote speaker at World Congress on Rheumatology & Orthopedics Conferenceheld by Scientific Federation. Dr. Nikolaos Christodoulou is going to talk on ‘Modified ALMIS approach using new generation screwed cups and short stems in hip arthroplasties’. A brief summary is presented here.

One of best MIS hip approaches is at least theoretically Röttinger’s muscles sparing Watson-Jones anterolateral approach in decubitus lateralis position but in our hands difficulties were present, especially during learning curve, to mobilize the femur without excessive supero-medial capsule and external rotators e.g. piriformis and/or obturator internus release in many cases. External rotators release increases hip laxity and longer arthroplasty necks are usually needed resulting to leg lengthening. In the presented personal new ALMIS hip approach for hip arthroplasty the opposite leg is stabilized at the posterior leg table support and not at the anterior that is removed. Only gluteus minimus insertion tendon accompanied by some not important anterior fibers of gluteus medius is temporary elevated and reinserted to its place at the end of operation. No any serious vessel’s branch is present at this approach so blood loss is very minimal. The operating leg is not placed in extension but in small flexion, adduction and external rotation during femoral preparation without stress on abductors. Opposite leg on its support in slight abduction and extension accompanied by slight anterior inclination of the table during femoral access facilitates even more femoral preparation in difficult cases. Excessive capsule or external rotators release is avoided almost in all cases. This approach can be used in all primary or secondary osteoarthritis even in dysplasia or congenital dislocation cases as also in obese patients. In these last cases, skin incision may easily be extended without e.g. lateral cutaneous nerve of the thigh or deep femoral artery branches limitations presented in anterior MIS approaches. Course in 725 patients operated with this new technique in 282 of them using a short curved antirotation uncemented stem in combination with a new generation biologically fixed threaded cup is spectacular compared to classic Hardinge approach cases using classic implants and more successful than our previously published less invasive and bloodless lateral MIS approach for hip arthroplasty. Mobilization and gait is immediate.

For More information: http://scientificfederation.com/rheumatology-orthopedics-2018/

BILATERAL HIP REPLACEMENT

Dr. Rajendra Kumar Kanojia who is Additional Professor in Department of Orthopedics at Post Graduate Institute of Medical Education and Research ,Chandigarh in India. Being a speaker at World Congress on Rheumatology & Orthopedics Conference held by Scientific Federation. Dr. Rajendra Kumar Kanojia is going to talk on ‘SAME SITIING BILATERAL HIP REPLACEMENT ADVANCES AND DISADVANTAGES INASIAN POPULATIONS’.A brief summary is presented on here.

A population especially in Indian subcontinent the habit of squatting for the various social and day today activities makes it more pertinent to operate bilateral AVN hips at same sitting as this not only helps economically in using the same surgical kit and antibiotics and drapes etc. reducing the cost of surgery and also helps in post-operative management. Patient becomes mobile with both the hip painless and active. Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry, Melloh Markus2010-10-01.Total joint replacements represent a considerable part of day-to-day orthopedic routine and a substantial proportion of patients undergoing unilateral total hip arthroplasty require a contralateral treatment after the first operation. This report compares complications and functional outcome of simultaneous versus early and delayed two-stage bilateral THA over a five-year follow-up period. The study is a post hoc analysis of prospectively collected data is from the department of orthopedics from a single surgeon. Total number of cases was 21,all were between the age group of 36-68 (avg. 52), operated by the posterior approach ,implant used was same in all (stryker ).Total duration of surgery being 2.5 hours, post-operative period was non-significant all responded well, only there was one CPN, WHICH WAS GIVEN BRACE SUPPORT.

Simultaneous bilateral total hip arthroplasty in India subjects seams very useful and helps economically also as this saves lot of money, time of surgeon and operation theatres time.

For More Information: http://scientificfederation.com/rheumatology-orthopedics-2018/

Fracture Healing

             

Scientific Federation invites all the participants from all over the world to attend International Summit on Rheumatology &Orthopedics during September 24-25 2018 at Madrid, Spain. Which includes Keynote presentations, Oral talks, Poster presentations and Exhibitions. 

Fractures are the most common large-organ, traumatic injuries to humans. The repair of bone fractures is a postnatal regenerative process that recapitulates many of the ontological events of embryonic skeletal development. Although fracture repair usually restores the damaged skeletal organ to its pre-injury cellular composition, structure and bio mechanical function, about 10% of fractures will not heal normally. The developmental progression of fracture healing at the tissue, cellular and molecular levels. Innate and adaptive immune processes are discussed as a component of the injury response, as are environmental factors, such as the extent of injury to the bone and surrounding tissue, fixation and the contribution of vascular tissues.

Fracture healing and bone repair are postnatal processes that mirror many of the ontological events that take place during embryonic development of the skeleton and have been extensively reviewed elsewhere. The recapitulation of these ontological processes is believed to make fracture healing one of the few postnatal processes that is truly regenerative, restoring the damaged skeletal organ to its pre-injury cellular composition, structure and bio- mechanical function. Interestingly, a comparison of the transcription of mouse callus tissues across a 21-day period of fracture healing showed that about one-third of the mouse homologous of the genes expressed by human embryonic stem cells are preferentially induced. Many of the homoerotic genes that control appendices limb development also show increased expression during fracture healing. We place these biological processes in the context of how trauma and the immune system, as a component of the injury response, are related to the developmental aspects of fracture healing. We then review the relationships between ontogeny and the recovery of skeletal function. Finally, we focus on specific biophysical, local and systemic therapies that have been used to promote fracture healing.

Optimizing conditions for the harvest, selection, expansion and formulation of osteogenic stem cell preparations is needed to advance the field of skeletal healing and to set the stage for developing new local and systemic therapies. We also need to develop better delivery systems for stem cells, growth factors and osteoinductive substances, and to explore systemic applications of osteogenic agents. Identification of appropriate experimental settings and measurable, meaningful clinical endpoints for human clinical trial design are also required.