- SuperPath: The Direct Superior Portal-Assisted Total Hip Approach. [Journal Article]
- JEJBJS Essent Surg Tech 2017 Sep 28; 7(3):e23
- The supercapsular percutaneously assisted total hip (SuperPath; MicroPort) approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that utilizes the interval between t...
The supercapsular percutaneously assisted total hip (SuperPath; MicroPort) approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that utilizes the interval between the gluteus minimus and the piriformis to access the hip capsule. The technique was developed to promote early mobilization, greater range of motion, and improved pain control. The major steps of this procedure are as follows: Step 1: Patient positioning. The patient is in the standard lateral decubitus position with the involved leg in the "home position," that is, 45° to 60° of flexion, 20° to 30° of internal rotation, and slight adduction by elevating the foot on a padded Mayo stand. Step 2: Surgical exposure. A skin incision is made from the tip of the greater trochanter 6 to 8 cm proximally in line with the femur in the home position, the gluteus maximus muscle is split by blunt dissection in line with the fibers, and the gluteus medius and minimus are retracted anteriorly and the piriformis tendon is retracted posteriorly to access to the capsule without dissecting any muscles. Step 3: Capsular incision. The capsule is incised along the path of the skin incision from the saddle of the femoral neck to 1 cm proximal to the acetabular rim. Step 4: Femoral preparation. A channel is created in the superior aspect of the femoral neck from the femoral canal to the center of the femoral head, using reamers, a round osteotome, and a curet. Step 5: Femoral broaching. Sequential femoral broaches are then used to complete the preparation and size the proximal femoral canal while the head and neck remain intact. Step 6: Neck resection. The femoral neck osteotomy is performed level with the broach neck, and Schanz pins are used to rupture the ligamentum teres and remove the femoral head. Step 7: Acetabular preparation and placement. Acetabular preparation and cup impaction are done through a portal without needing release of the iliotibial band or remaining external rotators. A sharp Romanelli self-retaining retractor (Innomed) and modified Zelpi self-retaining retractor (Life Instruments) are used. Step 8: Trial reduction. Trial reduction is completed using a bone hook and a T-handle to gently manipulate the femur. Step 9: Final implant assembly. Liner impaction is completed through the portal, and the remaining components are implanted. Step 10: Closure. Closure is limited to the capsule, fat, and skin, since no muscles are dissected during this procedure. A recent multicenter study describing nearly 500 SuperPath THAs noted a 30-day all-cause readmission rate of 2.3% and a transfusion rate of 3.3%5. The average length of stay was 1.6 days, with 91% of patients discharged home; 4.1%, to skilled nursing facilities; 3.8%, to home care; and 0.6%, to inpatient physical therapy facilities6.
- The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. [Journal Article]
- EOEFORT Open Rev 2018; 3(7):408-417
- Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative d...
Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI).Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain.Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis.Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO).FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery.If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO.THA can be performed following PAO with outcomes similar to a primary THA.Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears. Cite this article: EFORT Open Rev 2018;3:408-417. DOI: 10.1302/2058-5241.3.170042.
- [Electroacupuncture Relieves Visceral Hypersensitivity by Down-regulating Mast Cell Number，PAR-2/TRPV 1 Signaling, etc. in Colonic Tissue of Rats with Irritable Bowel Syndrome]. [Journal Article]
- ZCZhen Ci Yan Jiu 2018 Aug 25; 43(8):485-91
- CONCLUSIONS: EA of ST 37 and ST 25 can relieve visceral hypersensitivity in IBS rats, which may be associated with its effects in down-regulating the number of MC and the expression of PAR-2, TRVP 1, SP, CGRP and Try proteins in the colonic tissue.
- Dual offset metaphyseal-filling stems in primary total hip arthroplasty in dysplastic hips after a minimum follow-up of ten years. [Journal Article]
- IOInt Orthop 2018 Sep 19
- CONCLUSIONS: This study demonstrates that a dual offset tapered stem achieved excellent survivorship and stability, as well as good clinical outcome scores with minimal thigh pain and stress shielding in patients with arthritis and developmental dysplasia of the hip; a dual offset tapered stem may be a suitable option for primary total hip arthroplasty in this group.
- Infection safety of dexamethasone in total hip and total knee arthroplasty: a study of eighteen thousand, eight hundred and seventy two operations. [Journal Article]
- IOInt Orthop 2018 Sep 19
- CONCLUSIONS: In our study material, the use of a single 5-10 mg dose of dexamethasone did not increase the incidence of post-operative PJI. A low dose of dexamethasone may be safely used to prevent PONV and as part of multimodal analgesia on patients undergoing arthroplasty operation.
- Creatinine-Based Renal Function Estimates and Dosage of Postoperative Pain Management for Elderly Acute Hip Fracture Patients. [Journal Article]
- PPharmaceuticals (Basel) 2018 Sep 18; 11(3)
- Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not d...
Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m², 59.1 mL/min/1.73 m², 56.9 mL/min/1.73 m², 60.3 mL/min/1.73 m², 58.9 mL/min/1.73 m², and 79.1 mL/min/1.73 m², respectively (p < 0.0001). Mean difference to CKD-EPI was -10.4 mL/min/1.73 m² to 11.8 mL/min/1.73 m². Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.
- Percutaneous Palliative Surgery for Femoral Neck Metastasis Using Hollow Perforated Screw Fixation and Bone Cement. [Journal Article]
- JJJB JS Open Access 2017 Jun 26; 2(2):e0018
- CONCLUSIONS: Percutaneous HPS fixation and cementoplasty for the treatment of femoral neck metastasis is a minimally invasive technique that provides effective pain relief and early stabilization. This technique seems to be useful for patients with advanced cancer for whom open surgery would be hazardous.
- Femoroacetabular Impingement Syndrome: A Cause of Hip Pain in Adolescents and Young Adults. [Journal Article]
- MMMo Med 2017 Jul-Aug; 114(4):299-302
- The primary objective of this review is further education of the general practitioner, or family medicine physician, on an important, but often missed, cause of hip pain in the adolescent and young a...
The primary objective of this review is further education of the general practitioner, or family medicine physician, on an important, but often missed, cause of hip pain in the adolescent and young adult population, femoroacetabular impingement (FAI) syndrome. We hope that further understanding of the etiology, examination, diagnosis, and treatment of FAI, will lead to more accurate diagnosis and timely referral to the Orthopedic hip specialist for definitive treatment and management. Thus, preventing the complications, or late sequelae, associated with the condition.
- A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery. [Review]
- JAJ Adv Nurs 2018 Sep 19
- CONCLUSIONS: Music has the potential to improve outcomes of anxiety, pain and postoperative delirium, for patients undergoing hip or knee surgery. The low number of studies found indicates results should be treated with caution. Further studies are required to provide strong evidence generalizable to a broader population. This article is protected by copyright. All rights reserved.
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- Contemporary Blood Conservation in Hip and Knee Arthroplasty: Tranexamic Acid is an Important Piece of the Puzzle! [Editorial]
- JAJ Arthroplasty 2018; 33(10):3063-3064