Is a Cementless Dual Mobility Socket in Primary THA a Reasonable Option?

Background  

Dislocation after THA continues to be relatively common. Dual mobility sockets have been associated with low dislocation rates, but it remains unclear whether their use in primary THA would not introduce additional complications.     

Sleeve Gastrectomy Severe Complications: Is It Always a Reasonable Surgical Option?

Background

Laparoscopic sleeve gastrectomy (LSG) is widely adopted but exposes serious complications.

Methods

A retrospective database analysis was done to study LSG staple line complications in a tertiary referral university center with surgical ICU experienced in treatment of morbid obesity and complications. Twenty-two consecutive patients were referred between January 2004 and February 2012 with postoperative gastric leak or stenosis after LSG. Interventions consisted in the control of intra-abdominal and general sepsis; restoration of staple line continuity or revision of LSG; nutritional support; treatment of associated complications. Main outcome measures concerned success rates of therapeutic strategies, morbidity and mortality rates, LOS, and time to cure.

Results

Thirteen patients (59 %) were referred after failure of reoperation (seven fistula repairs were attempted). Three patients received emergency surgery in our center with transorificial intubation and jejunostomy formation. An endoscopic stent was tried in nine patients but failed in 84.6 % of cases within 20 days (1–161). Seven patients (32 %) necessitated total gastrectomy within 217 days (0–1,915 days) for conservative treatment failure. Procedures under general anesthesia were required in 41 % of cases, organ failure was found in 55 % of cases, and central venous device infection in 40 %. Mortality rate was 4.5 % (n?=?1). Patients with unfavorable evolution of LSG complications (death or additional gastrectomy) had more previous bariatric procedure (82 % vs. 18 %, p?=?0.003). Median time to cure was 310 days (9–546 days).

Conclusions

LSG exposes severe complications occurring in patients with benign condition. Endoscopic stents entail high failure rate. Total gastrectomy is required in one third of the cases.     

Damage Assessment of Retrieved Birmingham Monoblock Cups: Is Conversion to Dual-Mobility Head a Viable Revision Option?

Background

A novel revision technique for failed hip resurfacings involves retention of the acetabular cup, if well-fixed, which is mated to dual-mobility (DM) prosthesis in a traditional hip replacement configuration. It is unknown whether existing damage on the retained cup will result in unacceptable wear of the DM prosthesis.

Is Reverse Shoulder Arthroplasty a Reasonable Alternative for Revision Arthroplasty?

Background  

Reverse shoulder arthroplasty (RSA) improves function in selected patients with complex shoulder problems. However, we presume patient function would vary if performed primarily or for revision and would vary with other patient-specific factors.     

Is There Still a Place for Face-to-Face Meetings?

There is definitely an essential place for face-to-face meetings. We renew bonds; affirm and expand diversity; learn and share as both students and mentors; advance the field to the benefit of our patients; and gain wisdom from experienced and devoted leaders.     

Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option?

ObjectiveEndovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results.MethodA retrospective analysis of a prospectively maintained endovascular database (1998–2008) was conducted, which identified 673 consecutive patients with aortic aneurysms.ResultsNineteen patients (2.8%) were identified with infected aortic aneurysms, in which there were a total of 23 separate aneurysms (16 thoracic and seven abdominal). Six patients (32%) presented with rupture. Eleven patients (58%) had received antibiotics preoperatively for a median duration of 11 days (1–54 days). Fifteen of the 19 (79%) had positive blood cultures, with Staphylococcus aureus being the most common organism.All 19 patients underwent endovascular repair. There were three Type I endoleaks (one requiring conversion to open repair) and two Type II endoleaks. One patient developed transient paraplegia, resolved by cerebrovascular fluid (CSF) drainage, and one patient had a stroke.The 30-day mortality was 11%, and survival at median follow-up of 20 months (0–83 months) was 73%. All eight deaths in the series were related to aneurysm.ConclusionEndovascular treatment of infective aortic pathology provides an early survival benefit; however, concerns over on-going graft infection remain.     

Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?

Background  

Strategies for revising a ceramic-on-ceramic total hip prosthesis are controversial. Some consider reimplantation of a ceramic head on a well-fixed femoral stem inadvisable as it may lead to a fracture of the newly implanted head.