Treatment with ACP showed a significantly better clinical outcome than did treatment with HA, with sustained lower WOMAC scores. Treatment with HA did not seem to be effective in the patients with grade III gonarthrosis.

BackgroundThe tissue sparing surgery (TSS) concept means not only smaller incisions but also less tissue disruption, allowing decreased blood loss and improved function. However, TSS techniques can result in more complications related to the learning curve. The aim of this study was to compare the learning curve of an experienced surgeon with different TSS approaches for total hip replacement (THR) from a clinical and surgical point of view, focussing especially on complications related to the use of different geometric stems.Materials and methodsSixty patients scheduled to be operated for a primary THR were enrolled in the study and were randomly assigned to surgery by one of three different TSS approaches: lateral with mini incision (group A), minimally invasive anterior (group B) and minimally invasive antero-lateral (group C). Results from the three TSS groups were compared with a control group of 149 patients (group D).ResultsOur results reveal significantly reduced blood loss in the TSS groups compared with the control group, with no differences between the TSS groups. We found better early functional scores in the two minimally invasive groups (anterior and anterolateral), and a lower rate of complications with the antero-lateral TSS approach.ConclusionThe antero-lateral TSS approach seems to be safer and less demanding than standard THR surgery, and is suitable for use with different stems.

Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain.

Based on our results in the intertrochanteric fracture, use of PFNA should be recommended in cases of elderly and osteoporotic patients, while TGN should be used in more severely displaced fractures in patients with a slightly better bone mineral density.

Malpositioning of the acetabular component in total hip arthroplasty (THA) increases the risk of dislocation, reduces the range of motion and may contribute to bearing surface wear. During computer assisted navigation, the anterior pelvic plane is registered intraoperatively by percutaneous palpation, but this may be unreliable. The aim of our study was to evaluate the reliability of imageless navigation in acetabular positioning employing data acquisition in the supine position and surgery in the lateral position ('flip technique'). We report 24 patients affected by primary osteoarthritis undergoing THA in which implants were placed with a conventional free-hand technique using the acetabular transverse ligament for cup orientation. For imageless navigation we used Orthopilot-Aesculap software. All patients had a postoperative computed tomography (CT) scan at three months, using previously validated dedicated software for cup orientation. Data collected using navigation software were compared with CT measurements. The mean acetabular inclination and anteversion recorded intra-operatively using navigation software were respectively 41°5' (SD: 9.61) and 9°5' (SD: 4.01) respectively. The mean inclination and anteversion calculated post-operatively by the CT based image software were 44°2' (SD 5.83) and 14°4' (SD 6.42) respectively. There was a statistically significant difference between the anteversion values (p=0.04). Therefore, the acquisition of parameters in the supine position with surgery performed in the lateral decubitus position creates unreliable data concerning cup anteversion using an imageless navigation system, and therefore the 'flip technique' cannot be recommended.