Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane's score, Merle d'Aubigne score and the patient's likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane's score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability.

Background: Although different fixation techniques for the Akin osteotomy have been described in the literature, there are no many studies trying to analyze the differences between the types of fixation available. The aim of this study is to analyze if there are any differences between three types of staple fixation available in the market. Method: We present a retrospective study of 145 cases in which an Akin osteotomy was performed and fixed with three different kinds of implants staple A (28%), staple B (45%), and staple C (27%). Staple A is made out of stainless steel, and the surgeon mechanically controls the compression applied. Staple B increases the compression when heat is applied to it. Staple C has an intrinsic elastic memory that closes the osteotomy. In all cases, distal articular set angle, interphalangeal joint obliquity angle, and metatarsophalangeal angle were measured pre-operatively and 1.5 months post-operatively on dorsoplantar weight-bearing radiographs. Other details such as post-operative complications, implant migration, osteolysis, or fracture of the lateral cortex during surgery were also recorded. Results: Clinical and radiological results show no relevant differences between the three types of fixation. The mean angular corrections of DASA, interphalangeal joint obliquity angle, and metatarsophalangeal angle were 5, 12, and 21, respectively, for staple A; 4, 10, and 19, respectively, for staple B; and 7, 10, and 23, respectively, for staple C. The rates of intra-operative and post-operative complications were similar for all groups. There was one case of infection per group. We had five cases of delayed union two with staple A and three with staple C. In four cases, there was a loss of correction, two of them fixed with staple A and two with staple C. Seven cases developed a Südeck's syndrome, four of them fixed with staple A and three with staple C. Fifteen patients suffered an uncontrolled fracture of the lateral cortex of the phalanx when performing the osteotomy (3, 8, and 4 cases fixed with staples A, B, and C, respectively), and 87.5% of the patients that developed a plantar displacement of the osteotomy had an uncontrolled fracture of the lateral cortex (p < 0.05). All three staples achieved a rigid internal fixation and minimal periosteum damage and provided a good bone-bone contact. Conclusions: According to our results, the radiological differences are minimal, and although the thermal compression staple had less complication, clinical differences were also not statistically significant. This means the choice of implant could be left to the surgeon's preferences or made according to cost.

Background: There is some controversy about how the proximal tibiofibular joint (PTFJ) capsulotomy changes PTFJ anatomy in closed-wedge high tibial osteotomy (CW-HTO) and about how this affects ankle and knee mobility and the onset of lateral knee pain. The aim of this study is to evaluate changes in PTFJ after CW-HTO, and its possible clinical significance. Methods: This study includes 50 patients who underwent CW-HTO with tibiofibular capsulotomy from 2000 to 2018 in our hospital. A clinical evaluation was conducted to evaluate pain location. The degrees of osteoarthritis and the proximal fibular subluxation were evaluated on radiographs. A dynamic analysis of the PTFJ was also performed comparing proximal fibular head subluxation on anteroposterior knee radiographs with the ankle placed in neutral position and dorsiflexed. Results: The clinical evaluation revealed that two patients had a sore scar, five had pain on the PTFJ with manual compression, and none referred lateral compartment pain. The radiological analysis revealed an average proximal subluxation of the fibular head after the osteotomy of 9.64 (range: 0-29) mm, which was greater in oblique PTFJ (p < 0.05). After the surgery, all the patients developed some degree of PTFJ arthritis. There was no correlation between lateral pain and proximal fibular subluxation, tibiofibular arthritis, or lateral compartment arthritis. The dynamic analysis revealed no significant changes. Conclusions: After CW-HTO all the patients developed proximal subluxation of the fibular head and a variable degree of PTFJ osteoarthritis, but these changes seem to be unrelated with lateral knee pain. (C) 2020 Elsevier B.V. All rights reserved.