No abstract

Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring –3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23–98) compared to the average pre-operative score of 42.8 points (r: 0–56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13–70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).

To summarize a practical approach to the prevention of venous thromboembolism (VTE) in various patient groups undergoing orthopedic surgery or with lower extremity fractures. BACKGROUND: Patients undergoing hip arthroplasty, knee arthroplasty, hip fracture surgery and patients with major lower extremity injuries are at particularly high risk for VTE. In this population, routine use of thromboprophylaxis has been standard-of-care for many years. Before thromboprophylaxis was widely used, deep vein thrombosis (DVT), which was most often clinically silent, occurred in 40-60% of these patients; pulmonary embolism (PE) occurred in 5-10% of patients; and fatal embolism was one of the most common causes of death. The use of evidence-based thromboprophylaxis in these patients has been shown to reduce the risk of DVT by at least 50% and, as a result, major and fatal VTE are now uncommon. A large number of clinical trials have assessed many different thromboprophylaxis modalities in orthopedic surgery.