Search

Background: Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). Material and Methods: Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. Results: Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. Conclusion: The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.

Mounting evidence suggests that acute appendicitis (AA) is not one but two diseases: complicated appendicitis, which is associated with necrosis leading to perforation or periappendicular abscess, and uncomplicated appendicitis, which does not necessarily result in perforation. Even though AA is the most frequent cause of surgery from abdominal pain, little is known about the origins and etiopathogenesis of this disease, much less regarding the different disease types.In this study, we investigated the microbiome of samples from the appendix, rectum and peritoneum of 60 children and adolescents with AA to assess the composition and potential function of bacteria, archaea and fungi. The analysis of the appendix microbial community revealed a shift depending on the severity of the AA. This shift was reflected by two major community state types that represented the complicated and uncomplicated cases. We could demonstrate that complicated, but not uncomplicated, appendicitis is associated with a significant local expansion of oral, bacterial pathogens in the appendix, most strongly influenced by necrotizing Fusobacterium spp., Porphyromonas and Parvimonas. Uncomplicated appendicitis, however, was characterised by gut-associated microbiomes. Our findings support the hypothesis that two disease types exist in AA, which cannot be distinguished beyond doubt using standard clinical characterization methods or by analysis of the patient’s rectal microbiome. An advanced microbiome diagnosis, however, could improve non-surgical treatment of uncomplicated AA.ImportanceWith a lifetime risk of up to 17%, acute appendicitis is one of the most frequent causes of emergency abdominal surgery in westernized countries. Latest literature reports suggests that appendicitis manifests in two disease types: complicated and uncomplicated appendicitis with different, yet unknown, etiopathogenesis.In this study, we investigated the microbial composition (bacteria, archaea and fungi) from 60 children and adolescents that were diagnosed with acute appendicitis. Appendix, rectal and peritoneal samples were analysed using amplicon and metagenomic sequencing. Our results suggest that acute appendicitis manifests in three microbial state types that reflect complicated and uncomplicated appendicitis as well as special cases that are caused by bacterial overgrowth. Strikingly, uncomplicated appendicitis appears to be caused by gut-associated pathogens while complicated appendicitis is driven by oral-associated microbes such as Fusobacterium sp. or Porphyromonas sp. The findings provided in our study are of special interest to understand the etiopathogenesis of both complicated and uncomplicated appendicitis.