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Background: Total knee arthroplasty (TKA) is the standard treatment for terminal knee osteoarthritis. Simultaneous bilateral total knee arthroplasty (STKA) can be a cost-effective and practical option for patients with degenerative joint disease affecting both knees. The purpose of this study was to assess complication rates and functional outcomes following simultaneous versus staged bilateral total knee replacement., Material and Methods: Approximately 60 individuals who experienced debilitating knee osteoarthritis were enrolled in a prospective study with a randomized comparative design. Out of these, 30 patients underwent simultaneous total knee arthroplasty (STKA), while the remaining 30 individuals underwent two separate surgeries with a gap of 3-6 months between each procedure for both knees. After excluding 7 patients from both groups, a total of 53 patients were included in the study and followed up for at least 12 months., Results: Pre-operative demographic parameters were equated between both groups. The overall number of systemic complications was higher in the simultaneous group compared with the stagedone. Systemic complications were correlated with the elderly and high-risk populations. However, simultaneous procedures were safe in a low-risk group with shorter hospitalization and operative times., Conclusions: 1. Simultaneous bilateral total knee arthroplasty (TKA) is considered safe and feasible mainly for younger individuals with ASA 1 or 2 health status. 2. Patients undergoing simultaneous bilateral TKA experience significantly reduced hospital stays. 3. The procedure may not be advisable for elderly patients at a higher risk of systemic complications.

Background: Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture., Aim: To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries., Methods: A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score., Results: The results revealed a statistically significant difference between both groups ( P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group ( P = 0.513). A lower surgical site infection rate was noticed in the INFIX group ( P = 0.007)., Conclusion: Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures., Competing Interests: Conflict-of-interest statement: All authors confirm that there is no conflict of interest related to this study., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objectives: This study aims to compare dynamic hip screw (DHS) with trochanteric stabilizing plate (TSP) versus short proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the functional and radiological outcomes., Patients and Methods: Between June 2019 and March 2020, a total of 68 patients (32 males, 36 females; mean age: 69.7±8.2 years; range, 60 to 88 years) with unstable trochanteric fractures were included in this randomized-controlled trial. Eligible patients were randomized to undergo DHS with TSP (n=34) or short PFN (n=34) and followed for 12 months. The outcome measures including Harris Hip Score (HHS), operating room time, the amount of blood loss and need for intraoperative transfusion, return to activity, time to union, postoperative complications, failure rate, and mortality rate were analyzed., Results: The mean operative time in the DHS+TSP group was 105±10 min, while in the PFN group it was 94±8 min (p=0.001). The mean time until union in the DHS+TSP group was 10.1±1.9 weeks, while in the PFN group, it was 8.8±1.8 weeks (p=0.008). The mean time to return to the pre-fracture activity level in the DHS+TSP group was 12.6±2.6 weeks, while in the PFN group, it was 10.8±2.1 weeks (p=0.005). The mean HHS for the DHS+TPS group was 77.9±8.4, while for the PFN group, it was 80.4±8.7 (p=0.26). There was no significant difference in the walking capability between the two groups. One-year mortality rate was 29.4% in the PFN group and 17.6% in the DHS+TSP group (p=0.284), indicating no significant difference. Mechanical failure was recorded in three cases (8.8%) in the DHS+TSP group compared to two cases (5.8%) in the PFN group with no statistically significant difference. These five cases needed later revisions with total hip replacement., Conclusion: The use of PFN in unstable trochanteric fractures was associated with a shorter time until union and a faster return to the pre-fracture level of activity than the DHS+TSP group. Postoperative hip function, walking independence, as well as complication and one-year mortality rates were comparable.

Combined central acetabular and femoral neck fractures with intrapelvic femoral head dislocation is an infrequent situation that provides a problematic condition for surgeons attempting to reconstruct the hip joint. Herein, we report two cases involving central acetabular fracture-dislocation combined with intrapelvic dislocation of a fractured femoral neck. Each case involved associated injuries that made primary total hip arthroplasty (THA) impossible and necessitated using the fewest skin incisions possible. As a result, we first attempted a posterior acetabular fixation of both the anterior and posterior columns with intra-articular plating of the anterior column. Finally, a cementless acetabular cup was implanted. There were no complications identified during the stages of reconstruction up to and including THA. The two patients̓ final Harris Hip scores were 98 for the first patient (at five years), and 91 for the second patient (at 1 ½ years). In conclusion, staged reconstruction of the hip joint with intra-articular acetabular plating does not weaken the acetabular bone that can accept insertion of THA with cementless biological acetabular fixation without complications and with an acceptable clinical outcome up to five years.

Background: This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty., Methods: This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale., Results: Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery., Conclusion: Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power., Clinical Trial Registration: The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019; https://clinicaltrials.gov/ct2/show/NCT04005326)., Competing Interests: The authors reported no conflicts of interest for this work. This paper and the abstract of this paper have not been presented at a conference., (© 2021 Nassar et al.)

Fixation of comminuted vertically unstable sacral fractures continues to be a surgical dilemma. Although triangular osteosynthesis is a good construct and resists vertical translation, complications still occur. Herein, we introduce a new biplanar fixation technique, using segmental spinal instrumentation as an alternative to triangular osteosynthesis. This technique is remarkably valuable in cases with sacral morphology and/or complex fracture patterns that preclude safe percutaneous iliosacral screw insertion.

Purpose: We evaluated the potential advantages of short-segment fixation of certain anterior acetabular fracture patterns through a limited ilioinguinal approach., Methods: Two patient groups were studied. The first group comprised 22 patients (20 men, two women; average age 36 years) treated using the short-segment fixation protocol through a limited ilioinguinal approach. We modified the use of short pelvic brim plates, spring plates and posterior-column screws as reduction and fixation tools (leaving the distal end of the fracture unfixed) to keep the dissection entirely lateral to the iliac vessels. The second (control) group comprised 31 patients with matched fracture patterns fixed through the standard ilioinguinal approach. All patients were followed up for a minimum of two years. The estimated amount of blood loss (primary outcome measure), operative time, postoperative radiographic assessment of reduction quality and functional score assessment (secondary outcome measures) were compared between groups., Results: The short-segment-fixation group had significantly less blood loss (p < 0.0001) and shorter operative time (p = 0.002) compared with the control group. However, there were no significant differences in the quality of fracture reduction and functional scores between groups at the final follow-up. No major complications were encountered in either group., Conclusion: Short-segment fixation through a limited ilioinguinal approach is a safe and effective alternative for treating certain patterns of anterior acetabular fractures. Decreased blood loss and shorter operative time with less soft tissue dissection are the main advantages of this approach.