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Purpose The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure. Methods Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated. Results Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p < 0.001), NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p Conclusions Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined. Level of evidence IV: retrospective comparative trial.

Direct anterior approach total hip arthroplasty (DAA THA) has gained significant popularity in the last decade as it is a muscle-sparing procedure. Modern techniques for DAA THA utilize both a standard operating table and an orthopedic traction table. As the use of an orthopedic traction table shows technical ease and predictability, this article will focus on the use of the orthopedic table or table extension to facilitate DAA THA. Primary or secondary arthritis requiring THA; revision surgery—both acetabular and femoral. Posterior wall hardware requiring removal; posterior mass (tumor) to be removed at surgery: large, overhanging pannus; need for gluteal tendon reconstruction; anterior skin envelope not conducive to DAA. The incision is made over the tensor fascia latae. Capsulotomy is performed exposing the hip joint. After osteotomy of the femoral neck, traction is placed on the leg utilizing the orthopedic table and the head is removed. The acetabular cup is inserted. Traction, flexion, and internal reduction are used simultaneously while directing the femoral head into the acetabulum. In a meta-analysis, operative time (100 vs. 71 min), blood loss (531 vs. 382 ml), and intraoperative fracture rate (1.7 vs. 1.3%) were increased in the traction table cohort. All other complications and outcome measurements were the same. Traction-table related complications such as pudendal nerve palsy and ankle fractures were not found. An assessment of the senior author’s initial 855 DAA THAs (2008–2014) showed a mean operative time of 65 min with a mean blood loss of 238 ml. Operative times decreased to average 56 min. Intraoperative fracture rate was 0.8%. Infection rate was 2.1%. Finally, 1.5% femoral implants did not osseointegrate and required revision after an average of 3.0 years.

Greater trochanteric pain syndrome (GTPS) refers to the constellation of signs and symptoms related to pain in the trochanteric region and has recently replaced the previously ubiquitous term of ‘greater trochanteric bursitis’. GTPS is common, particularly in women 50–79 years of age, and the understanding and management of GTPS have expanded considerably in recent years to include management with arthroscopic and endoscopic techniques in recalcitrant cases. The purpose of this scoping literature review was to summarize the current evidence on arthroscopic management of GTPS including sources of evidence, key concepts, and gaps in the literature. A thorough electronic database search included studies published from 2009 to June 14, 2020. A total of 52 peer-reviewed articles were identified within the literature on arthroscopic or endoscopic management of GTPS. Of the 52 identified papers, 12 were technique descriptions, 10 papers were review articles, and 30 papers were original clinical papers. Of the 30 clinical papers, 24 (80%) were of level IV evidence, 5 (17%) were of level III evidence, and 1 (3%) was level II evidence. Among the 30 clinical studies, 988 patients were included with 761 (77%) female. Indications for surgical management included a failed trial of conservative management in all 30 studies, typically after a period of 3–6 months. Surgical management consisted of arthroscopic/endoscopic abductor tendon repair in 16 (53%) studies, arthroscopic/endoscopic bursectomy and iliotibial band release in 12 (40%) studies, and arthroscopic/endoscopic gluteal tendon contracture release in 2 (7%) studies. Overall, results following arthroscopic management of GTPS and abductor tears have been promising, including significantly improved pain scores and functional outcomes at final post-operative assessment. These studies support continued use and investigation of arthroscopic management strategies of GTPS and pave the way to conduct larger prospective studies to confirm these results in the future. IV.

Purpose Snapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. When the snap is perceived at the lateral side of the hip, this condition is known as external snapping hip or lateral coxa saltans, which is usually asymptomatic. Snapping hip syndrome (SHS) refers to a painful snap, which is more common in athletes who require increased hip range of motion. The aim of this article is to review the most common endoscopic techniques for the treatment of ESHS, as well as their results and limitations. Methods This is a review of the current literature of endoscopic surgical procedures and of the results of the treatment of external snapping hip syndrome. Results The pathogenesis of SHS is mechanical. The initial treatment attempt is conservative, and usually provides good results. Patients who do not respond to conservative management are candidate for surgery. The endoscopic release of the ilio-tibial band or the endoscopic release of the femoral insertion of the gluteus maximum tendon is the most popular technique. Conclusion Endoscopic techniques provide fewer complications compared to open surgery, a lower recurrence rate and good clinical outcomes. More comparative studies with a longer follow-up are required to adequate evaluate the full role of endoscopic techniques in periarticular hip surgery. Level of evidence Level V.

Minimally invasive approach in total hip arthroplasty for the treatment of femoral neck fractures with a hemiarthroplasty.Femoral neck fractures of patients without hip osteoarthritis where the acetabulum is still intact.Lesions and infections of the skin in the approach area; hip osteoarthritis; surgeon's lack of experience with the technique.The direct anterior approach (DAA) uses the Smith-Peterson interval between the tensor fasciae latae (TFL) and the rectus and sartorius muscle. After coagulation of the ascending branches of the femoral circumflex vessels, the capsule is opened. The remaining parts of the femoral neck are removed and osteotomized if necessary. The femoral head is removed with a cork screw. Then the shaft is supported by 2 sharp retractors at the greater trochanter from cranial, and the leg is externally rotated, hyperextended, and adducted. A TFL release can be performed which we also recommend. The femoral canal is opened step by step and extended with rasps which are introduced with the double curved broach handle. Cement and the final implant are introduced and after the trial reduction also the final head. The hip is reduced, the capsule adapted and the wound closed.For this approach, there are no approach specific recommendations. Postoperative treatment depends on whether the approach was extended with muscle releases and on the type of reconstruction performed. If the approach was limited to the minimally invasive direct anterior portal, quicker rehabilitation can be expected due to the reduced muscle damage. We prefer mobilization with full weight bearing as tolerated on the next day.OPERATIONSZIEL: Der minimalinvasive Zugang ist muskelschonend, erlaubt eine rasche Operation und frühe Mobilisation.Indikationen für eine Versorgung mit einer Hemiarthroplastik sind Schenkelhalsfrakturen in Fällen ohne Koxarthrose, in denen das Azetabulum noch intakt ist.Läsionen und Infektionen der Haut im Zugangsgebiet, Koxarthrose sowie die fehlende Erfahrung des Operateurs sind Kontraindikationen.Der direkte anteriore Zugang erfolgt über das Smith-Peterson-Intervall zwischen M. tensor fasciae latae (TFL) und M. rectus bzw. M. sartorius. Unter Koagulation der aufsteigenden Äste der Vasa circumflexa femoris wird die Kapsel dargestellt und eröffnet. Die freien Schenkelhalsreste werden entfernt, und eine glatte Osteotomie wird auf der gewünschten Höhe hergestellt. Der Hüftkopf wird mit einem Korkenzieher entfernt. Der Schaft wird mit einem 2‑spitzigen Heben am Trochanter major von kranial her unterstützt und das Bein in Außenrotation, Hyperextension und Adduktion gebracht. Zur Verbesserung der Exposition des Femureingangs kann ein TFL-Release erfolgen, was die Autoren empfehlen. Danach wird der Markkanal schrittweise eröffnet und mit Raspeln, die an einem doppelt kurvierten Handgriff befestigt sind, erweitert. Zement und das finale Implantat werden eingebracht und nach Probereposition auch der definitive Kopf. Danach wird die Hüfte reponiert, die Kapsel adaptiert und die Wunde verschlossen.Für diesen Zugang gibt es keine zugangsspezifischen Empfehlungen. Die postoperative Behandlung hängt von vorgenommenen Erweiterungen des Zugangs mit Muskelablösungen und der Art der erfolgten Rekonstruktion ab. Wenn der Zugang auf das minimalinvasive direkte anteriore Portal beschränkt war, ist durch den reduzierten Muskelschaden eine deutlich raschere Rehabilitation zu erwarten. Die Autoren empfehlen Mobilisation mit voller Belastung, falls erträglich, am nächsten Tag.

Less invasive direct anterior approach (DAA) and dual mobility cup (DMC) are increasingly adopted in practice over the last decade. Their use aims to reduce, as much as possible, soft tissue dissection and dislocation rate. This study aims to present a novel surgical technique to reduce a DMC prosthesis during a DAA easily. A mildly modified version of the direct anterior approach is proposed. When leg lengths, stability, impingement, and tension have been checked, the trial stem is disassembled in situ, dislocated, and removed, leaving the space to exchange the trial double mobility head with the definitive one. When the definitive stem is inserted, the surgeon guides and helps the assistant to match the trunnion in the double mobility head. As soon as the components are matched, the traction is released, and the unit is impacted by an alternation of axial traction and release. Of 164 patients who underwent primary total hip arthroplasty (December 2016–May 2017) by a single surgeon, a double mobility cup through DAA and the “head-first” technique was performed in 26 patients (15.8%). The mean operative time was 130 min (85–220 min; SD 34.28). No significant complications occurred during the mean follow-up of 23.6 months. Specific difficulties can be anticipated when pairing dual mobility cup and direct anterior approach. The “head-first” technique is a useful technique in reducing the possible difficulties related to the reduction of double mobility cup through a less invasive direct anterior approach.

Floating hip fractures are severe and rare injuries with high complication rate and lack of standard management. The purpose of this retrospective study was to review the outcomes of a case series of polytraumatized patients with floating hip injuries, in order to describe the relationship between complication rate and floating hip injury type, the pathomechanism of injury, and the surgical treatment strategy. Forty-five patients with floating hip injuries were analyzed. Complication rate, mechanism of injury, and surgical strategy (damage control orthopedics, stages of internal fixation) were recorded. Fractures were classified using the Mueller system for floating hips and AO/OTA system for the other fractures. Of the 45 patients with floating hip injuries, 23 (51.1%) developed complications. The results revealed that the complication rate was associated with the instability and type of the pelvic or acetabular fracture (61-C AO/OTA pelvic fracture [73.3%; p = 0.04], 62-B AO/OTA acetabular fracture [88.8%; p = 0.03]). Vertical shear (VS) pelvic fractures were related to middle-distal femoral fractures and lateral compression/anteroposterior compression (LC/APC) pelvic lesions were associated to proximal femoral fractures (p = 0.012). Complications were associated with the severity and instability of the pelvic and acetabular type of fractures. The pathomechanism causing Mueller type B and C floating hip injuries was illustrated. A two-stage “femur first” surgical approach was the preferred one for definite internal fixation of fractures.

The purpose of this study was to investigate the pathogenesis, the incidence, and the results of arthroscopic treatment of os acetabuli (OSA) in a group of patients with diagnosis of femoro-acetabular impingement (FAI). We retrospectively analyzed the full documentation of 294 hips in 273 patients (21 bilateral) operated for FAI through hip arthroscopy. We reviewed all radiographs and arthro-MRI in order to identify the incidence of OSA. All patients with OSA were then assessed with a modified Harris hip score (MHHS) pre-operatively and at the final follow-up. Twenty-one patients (7.7%), 20 (95%) of them were male, were diagnosed with concomitant FAI and os acetabuli. In 21 cases, OSA was excised and FAI was treated with rim trimming, femoral osteoplasty, or both. In one case, a large OSA fragment was fixed with a 4 mm screw avoiding an acetabular uncoverage if excised. The average follow-up was 31 months (range from 6 to 69 months). The MHHS showed an improvement from a pre-operative MHHS of 57.5 (range from 39 to 82) to 95 (range from 73 to 100). Os acetabuli is not uncommon and certainly associated with FAI and male gender. The etiology is probably microtraumatic. The arthroscopic OSA removal or fixation and concomitant FAI treatment showed very good results. Interestingly, these outcomes seem better than FAI treatment alone. Further studies with a wider number of patients and a longer follow-up are needed to confirm these results and understand the real role of OSA in this setting.

FAST-TRACK OF PROXIMAL FEMUR FRACTURES IN PATIENTS OVER 65 YEARS: ANALYSIS OF THE EPICRISIS AND DEVELOPMENT OF EFFECTIVE ORGANIZATIONAL MODELS During the Trauma Meeting 2017 in Riccione an important Round Table took place entitled “Analysis of the epicrisisand development of effective organizational models” within the session “Fast-track of proximal femur fractures inpatients over 65 years”. Given the great relevance of the topic and the precious contribution of the participants, it wasdecided to create the following scientific manuscript of Discussion and Consensus, which contains the answers to thefive questions that were the subject of the Round Table.

The most common conservative approaches to the hip joint are the anterior, the Ganz safe surgical dislocation and the medial approach. The anatomy of these approaches is described in detail in this review. Each approach is also evaluated considering the surgical conservative indications, technique, and complications.

Objective To compare image quality of magnetic resonance arthrography (MRA) of the hip with intra-articular injection of high-viscosity hyaluronic acid (HA-MRA) versus Gd-based contrast agent (Gd-MRA) in patients with femoroacetabular impingement (FAI). Materials and methods Design: single-centre, observational, retrospective, inter-individual, and cross-sectional. FAI patients who underwent HA-MRA (3 mL of high-viscosity HA plus 17 mL of saline) were compared with 37 age- and sex-matched FAI patients who underwent Gd-MRA (20 mL of 2 mmol/L solution of gadopentetate dimeglumine). Two independent blinded radiologists assessed image quality for all sequences (two-dimensional proton density, non-fat-sat axial, fat-sat coronal and sagittal; three-dimensional dual-echo steady state), using a 5-point Likert scale considering separately labrum, cartilage, round ligament, transverse ligament, and capsule. Pearson χ2 and Cohen κ were used. Results The HA-MRA group was composed of 37 patients (23 males, 14 females; median age 38 years), the Gd-MRA group of 37 patients (21 males, 16 females; median age 38 years), without significant difference for age (p = 0.937) and sex (p = 0.636). Image quality did not differ between the two readers for any structure: labrum (p ≥ 0.340), cartilage (p ≥ 0.198), round ligament (p ≥ 0.255), transverse ligament (p ≥ 0.806), and capsule (p ≥ 0.314). Inter-reader agreement (κ) ranged from 0.785 to 1.000. Conclusions HA-MRA provided an image quality not significantly different from that of Gd-MRA. This may open the possibility of combining MRA and viscosupplementation in one single procedure.

The objective of this study was to compare survival rate and clinical and radiological outcomes of a cementless mobile-bearing total ankle replacement (TAR) between two groups of patients, affected by end-stage ankle arthritis, with or without a pre-operative varus deformity.A total of 81 patients (81 ankles) were included in the study and divided in two groups. Group A, "varus" group, includes 11 patients with pre-operative varus deformity of more than 10 ° and group B, "neutral" group, includes 70 patients, with a varus/valgus deformity of less than 10 °. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and Short Form (SF)-12 score were used to compare clinical outcomes. Radiological parameters, complications, and survival rate at last follow-up were also recorded.In both groups, all clinical and radiological parameters improved after surgery (p 0.05) without statistically significant difference. Complications were similar between two groups. Overall in three cases, an implant revision was necessary: 1 in group A (9%) at 3.1 years follow-up and 2 (3%) in group B at 3.8 years, without statistically significant difference (p 0.001).Severe varus malalignment should not be considered a contraindication for a mobile-bearing TAR. Nevertheless, TAR in severe deformity should be performed only by experienced surgeons.

Total hip arthroplasty (THA) for post-traumatic osteoarthritis is a challenging surgery. Several factors should be considered to achieve a successful result: infection risk, surgical approach, possibly hardware removal, ectopic ossification, acetabular bone loss, nonunion and deformity. Different strategies are present in literature. This paper provides a wide revision of available literature. A personal diagnostic and treatment algorithm is proposed to guide surgeons in this atypical decision-making process.

The treatment of fracture sequelae of proximal humerus is still a challenge. Shoulder arthroplasty improves pain and Range Of Motion (ROM) but the results are inferior to the outcomes currently obtained in primary osteoarthritis or acute trauma. Anatomical and reverse total shoulder prosthesis are becoming increasingly popular because of better results than hemiarthroplasty.

Anticoagulant prophylaxis for preventing VTE is a world wide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures. Different guidelines are available in literature with quite different recommendations. None of them is a multidisciplinary effort as the one presented. In 2010 the Italian Society on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedics and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), have set down practical suggestions for VTE prophylaxis in hip and knee surgery as well as in femoral neck fracture treatment. This Intersociety Consensus Statement aimed at simplifying the grading system reported in the literature, and its goal was to favour its clinical application. Special focuses addressed fragile patients and those patients at high risk of bleeding or receiving chronic antiplatelet and vitamin K antagonists treatment, and a special chapter was dedicated to regional anaesthesia and VTE prophylaxis. The registration of three novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) for VTE prophylaxis in major orthopedic surgery and the ongoing introduction of these drugs for the prevention of embolism in atrial fibrillation make it necessary an update of the Intersociety Consensus Statement.

Preoperative planning is a fundamental step to successfully perform knee replacement surgery. Detailed knowledge of the surgical procedures and careful organisation of the medical staff are an important responsability for the orthopaedic surgeon, which must remain a reference point for the patient also outside the operating theatre.

Anticoagulant prophylaxis for preventing VTE is a world wide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures.Different guidelines are available in literature with quite different recommendations.None of them is a multydisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) have set down easy and quick suggestions for TEV prophylaxis in hip and knee surgery as well as in femoral neck fracture treatment. This intersociety consensus statement aims at simplifying the grading system reported in the literature, and its goal is to favour its clinical application. Special focuses have been also pointed toward fragile patients and on those patients at high risk of bleeding or receiving chronic antiplatelet and Vitamin K antagonists treatment. A special chapter have been dedicated to regional anaesthesia and TEV prophylaxis.

The intervertebral disc prosthesis seems to have gained its place in spinal surgery. The first 45 disc replacements (36 patients) performed at our institution have been followed for 5–9 years with standard radiography, CT, MRI and clinical evaluation. Two prostheses failed and needed further surgery. The mean Oswestry Disability Index score dropped from 44% to 9% and the pain score recorded on a visual analogic scale (VAS) dropped from 8 to 1.4. 92% of patients had excellent or good results and gave a positive answer to the question “Would you be ready to sustain again this same surgical procedure?” In 4 cases, a tendency towards prosthesis subsidence was observed. With time, 6 patients showed periprosthetic calcifications. One patient developed retrograde ejaculation. In conclusion, intervertebral disc prosthesis is a well established procedure that achieves good mid-term results, but doubts still remain about the longterm outcome. Care about right indication, eventual complications and assessment of long-term results are key points for the future of this procedure.

Data from a prospective, multicentre observational study (Studio GIOTTO) were analyzed to determine, in clinical practice, the pattern of VTE prophylaxis and adherence to international guidelines recommendations in major orthopedic surgery (MOS) - including total hip arthroplasty (THA), total knee arthroplasty (TKA) and hip fracture surgery (HFS) - and knee arthroscopic surgery (KAS).In 2010, the first consecutive 30 patients hospitalized in Italian centers for MOS and the first 15 for KAS were enrolled and treated according to the usual practice.2010 patients were admitted for MOS (577 TKA, 787 THA and 646 HFS) and 993 for KAS; mean ± SD age was 71.7 ± 8 and 43.0 ± 15 years, and female prevalence was 65.6% and 31.1% in MOS and KAS, respectively. Most (66.7%; 95% CI: 65-69%) patients admitted for MOS received a combined VTE prophylaxis, consisting of both pharmacological and physical tools, and 33.2% (95% CI: 31-35%) only pharmacological. For KAS figures were 23.7 (95% CI: 21-26%) and 75.3% (95% CI: 72-77%). Most MOS (91%; 95% CI: 89-92%) and KAS (95% CI: 98-100%) patients receiving pharmacological thromboprophylaxis were treated with low molecular weight heparin (LMWH), for (median) 40 days in TKR, 39 days in THR, 44 in HFS, and 16 in KAS. Patients receiving35 days of LMWH prophylaxis among those undergoing THR and HFS were 8.9% and 5.9%, respectively.Although most patients undergoing orthopedic surgery received VTE prophylaxis, a gap between clinical practice and international guideline recommendations was observed. The reduced adherence to guideline recommendations is relevant for certain choices like type and duration of VTE, and physicians' behavior may reflect the changing approach of guidelines in their different editions.

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

Infection after total hip arthroplasty is an orthopaedic surgeon major concern. Overall infection incidence has not been reduced in the last few decades (Charnley 1972) assessing its incidence between 0.5% and 2% for primary total hip replacement and around 4% for partial hip arthroplasty (Wilson et al. 2008) and for revision. Diagnosis and treatment are often long and difficult and final results unpredictable.

Anticoagulant prophylaxis for preventing VTE is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them is a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to foster its clinical application. This statement is therefore addressed to the Italian scientific community and institutions with the aim of attaining good clinical practice in the profession. The present statement will be published in the “Journal of Orthopaedics and Traumatology”,” Lo Scalpello” and in the websites of the Societies participating this consensus (OTODI, SIAARTI, SIMG, SIOT, SISET). It will be submitted to Minerva Anestesiologica.

Study Design. A new method is described of compressed root identification and discectomy for extraforaminal disc herniation, by a lateral intertransversalis approach. Objectives. To describe a safe surgical approach that does not require resection of adjacent bone structures during extraforaminal discectomy. Summary of Background Data. Most earlier series have reported approaches that damaged bordering bone structures with wide laminoarthrectomy. This is an attempt at a safer, simpler surgical approach. Methods. Thirteen patients with lateral hernia have undergone this surgical procedure since 1995. Herniectomy was performed after identification of the compressed root within the iliopsoas muscle. Results. All the patients resumed the upright position with the aid of a semirigid brace 24 hours after surgery. Upon awakening from the anesthesia, no patient reported peripheral pain. Motor deficits resolved after physical rehabilitation in all but one patient. At a mean follow-up of 14 months, there was no report of back pain. Conclusion. The procedure described in this article offers a simple alternative to the valid procedures presently at hand. It offers the advantage of no bone resection and of minimizing nerve structures manipulation.

Background Open hip surgery is known to be a risk for heterotopic ossification (HO), and nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely recognized as an effective prevention. Hip arthroscopy is gaining popularity thanks to the possibility of treating femoroacetabular impingement (FAI) with a minimally invasive technique, however little is known about its rate of postoperative HO. The aim of the present study is to evaluate HO prevalence after hip arthroscopy for FAI and its relationship with NSAID prophylaxis. Materials and methods We retrospectively reviewed 300 FAI cases who have been managed with hip arthroscopy in two different hospitals from April 2006 to May 2009. All medical records and indications at discharge were analyzed, focusing on administration of NSAIDs, as well as follow-up roentgenograms with regard to presence of HO around the hip joint. The patients were divided into two groups: a treatment group of 285 hips which received NSAID prophylaxis and a control group of 15 hips which did not. Results Five hips presented HO, with overall prevalence of 1.6%. All five patients with HO belonged to the control group. No HO was observed in the treatment group. Thus, HO rate turned out to be significantly higher (P

Anticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedists and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) have set down easy and quick suggestions for VTE prophylaxis in hip and knee surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and its goal is to benefit its clinical application. Special focus is given to fragile patients, those with high bleeding risk, and those receiving chronic antiplatelet (APT) and vitamin K antagonists treatment. A special chapter is dedicated to regional anaesthesia and VTE prophylaxis.