Overcoming Boundaries of Worldwide Joint Arthroplasty Registers : The European Arthroplasty Register Minimal Dataset

Worldwide joint arthroplasty registers are instrumental to screen for complications or implant failures. In order to achieve comparable results a similar classification dataset is essential. The authors therefore present the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) European Arthroplasty Register (EAR) minimal dataset for primary and revision joint arthroplasty. Main parameters include the following: date of operation, country, hospital ID-code, patient’s name and prename, birthday, identification code of the implant, gender, diagnosis, preoperations, type of prosthesis (partial, total), side, cementation technique, use of antibiotics in the cement, surgical approach, and others specifically related to the affected joint. The authors believe that using this minimal dataset will improve the chance for a worldwide comparison of arthroplasty registers and ask future countries for implementation.     

Digital comparison of planned and implanted stem position in total hip replacement using a program form migration analysis

Aim

One main goal in primary total hip replacement is the reconstruction of preoperative biomechanical conditions by adequate implant positioning. Our aim was to compare the planned and effectively implanted stem position in using a program for digital migration measurement.

Patients

We examined 120 cases with this new method based on a modification of the EBRA-FCA program and compared these results to direct plain radiographic methods. In addition, the intra- and inter-observer reliability was determined in 50 cases.

Results

We observed a rate of correct prediction of 80% for the size of the stem. The new method revealed a good correlation (0.95 and 0.64 for the position along the stem axis and 0.84 for the stem angle) to direct plain radiographic methods. Regarding the intraclass correlation coefficient for intra- and inter-observer reliability, the results were superior (0.97 vs. 0.81?C0.84 and 0.90 vs. 0.74?C0.88) compared with direct plain radiographic methods.

Conclusion

We concluded that the comparison of the planned and implanted stem position using a modified EBRA-FCA method is more reproducible than direct radiographic measurements.     

Ulcus vulvae acutum Lipschütz: a systematic literature review and a diagnostic and therapeutic algorithm

The case report literature on ulcus vulvae acutum Lipschütz (UVAL) is scant, and specific guidelines on its diagnosis and treatment are lacking. Our study's aim was to perform a systematic literature review of UVAL in order to formulate a diagnostic and therapeutic algorithm. Using the PRISMA criteria, we searched PubMed and MEDLINE for the terms ‘ulcus vulvae acutum’, ‘Lipschütz ulcer’ and ‘acute genital ulcer AND vulva’. We extracted relevant data on ‘type of article’, ‘patients’ age’, ‘amount and localization of ulcers’, ‘presence of flu-like symptoms’, ‘prior sexual contacts’, ‘diagnostic workup’ (including histology, blood count and serology such as Epstein–Barr virus testing) and ‘treatment/outcome’. Data were meta-analysed and comparative analyses were discussed in order to create a diagnostic algorithm and recommendations for management. Twenty-one publications reporting a total of 60 cases of UVAL were included for analysis. On this basis, we formulated a diagnostic and therapeutic algorithm defined by two major and four minor criteria. The major criteria were (i) acute onset of one or more painful ulcerous lesions in the vulvar region and (ii) exclusion of infectious and non-infectious causes for the ulcer. The minor criteria were (i) localization of ulcer at vestibule or labia minora, (ii) no sexual intercourse ever (i.e. patient was a virgin) or within the last 3 months, (iii) flu-like symptoms and/or (iv) systemic infection within 2–4 weeks prior to onset of vulvar ulcer. Use of a symptom-based treatment algorithm based on our proposed major and minor criteria will improve the diagnosis and management of UVAL.     

In vivo testing of knee stability after rotating-hinge total knee arthroplasty: a comparison of 2 knee systems

Rotating-hinge knee prostheses are used for reconstruction in cases of severe articular compromise and major bone loss. Biomechanical studies revealed that rotating-hinge designs with long and cylindrical pegs are more stable than devices with short and more tapered ones. Twenty-five patients underwent clinical examination using ultrasound, radiographs, and 3 different rating systems to examine the in vivo stability and functional outcome of 2 rotating-hinge knee systems. Overall, the study revealed that a stable reconstruction could be achieved with both tested devices, with good functional outcome. The results for medial and lateral lift-off during flexion and extension in ultrasonography were comparable, whereas the measured distraction of the Limb Preservation System (LPS/M.B.T.; DePuy, Warsaw, Indiana) was lower compared with the S-ROM Noiles prostheses (DePuy). The implant, the new formed capsule, and the remaining soft tissues have to maintain joint stability. Soft tissue reconstruction, especially the medial gastrocnemius flap, and the newly formed periprosthetic scar seems to prevent distraction of several millimeters. In addition, determining the lift-off with ultrasonography showed that the shape of the peg does not influence implant's stability against lateral directed forces.