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Background: Acetabular component malposition is a major cause of dislocation following total hip arthroplasty (THA). Intellijoint HIP is an imageless navigation tool that has been shown to provide accurate intraoperative measurement of cup position during primary THA without substantially increasing operative time. However, its accuracy in revision THA has not been evaluated. This study therefore aims to assess the accuracy of Intellijoint HIP in measuring cup inclination and anteversion in comparison with computed tomography (CT) during revision THA. Methods: Intellijoint HIP was used to measure the position of the preexisting cup in 53 consecutive patients undergoing revision THA between December 2018 and February 2020. Two authors blinded to the intraoperative navigation measurements also independently measured cup position using preoperative CT according to Murray's radiographic definitions. Pearson correlation coefficients with 95% confidence intervals (CIs), paired t tests and Bland-Altman plots were used to assess agreement between navigation-and CT-measured cup position. Statistical analysis was performed using GraphPad Prism, with p values less than 0.05 indicating statistical significance. Results: There was excellent agreement between navigation and CT measurements for both cup inclination (r = 0.89, 95% CI 0.81-0.93) and anteversion (r = 0.93, 95% CI 0.88-0.96), with the mean absolute difference being 5.2[degrees] (standard deviation [SD] 4.0[degrees]) for inclination and 4.8[degrees] (SD 5.4[degrees]) for anteversion. The navigation measurement was within 10[degrees] of the radiographic measurement in 47 of 53 (88.7%) cases for inclination and 46 of 53 (86.8%) cases for anteversion. Conclusion: Imageless navigation demonstrated excellent correlation and agreement with CT measurements for both inclination and anteversion over a wide range of acetabular component positions. Contexte: La malposition de la composante acetabulaire est une cause majeure de luxation apres une intervention pour prothese totale de la hanche (PTH). Intellijoint HIPMD est un outil de navigation sans image qui offre une mesure peroperatoire precise de la cupule aceta-bulaire lors d'une PTH primaire, sans prolonger indument le temps operatoire. Par contre, sa precision lors d'une revision de PTH n'a pas ete verifiee. Cette etude vise donc a evaluer la capacite d'Intellijoint HIP a mesurer precisement l'inclinaison et l'anteversion de la cupule acetabulaire en comparaison avec la tomodensitometrie (TDM) lors d'une revision de PTH. Methodes: Intellijoint HIP a ete utilise pour mesurer la position de la cupule preexistante chez 53 patients consecutifs soumis a une revision de leur PTH entre decembre 2018 et fevrier 2020. Deux auteurs non informes des mesures peroperatoires obtenues avec l'outil de navigation ont aussi mesure de facon independante la position de la cupule a l'aide d'une TDM preoperatoire selon les definitions radiographiques de Murray. Nous avons utilise les coefficients de correlation de Pearson avec des intervalles de confiance (IC) a 95 %, des tests t apparies et des graphiques Bland-Altman pour evaluer la concordance entre la position ace-tabulaire mesuree avec l'outil de navigation et par TDM. L'analyse statistique a ete effectuee avec GraphPad Prism et les valeurs p inferieures a 0,05 indiquaient une portee statistique. Resultats: On a observe une excellente concordance entre les mesures obtenues avec l'outil de navigation et par TDM pour l'inclinaison (r = 0,89, IC a 95 % 0,81-0,93) et l'anteversion de la cupule (r = 0,93, IC a 95 % 0,88-0,96),l'ecart absolu moyen etant de 5,2[degrees] (ecart-type [E.-T.] 4,0 [degrees]) pour l'inclinaison et de 4,8 [degrees] (E.-T. 5,4 [degrees]) pour l'anteversion. La mesure au moyen de l'outil de navigation s'est retrouvee a l'interieur d'une limite de 10 [degrees] par rapport a la mesure radiographique dans 47 cas sur 53 (88,7 %) pour l'inclinaison et 46 cas sur 53 (86,8 %) pour l'anteversion. Conclusion: La navigation sans image a donne lieu a une correlation et une concordance excellentes avec les mesures par TDM pour l'inclinaison comme pour l'anteversion et ce, dans un vaste eventail de positions de la composante acetabulaire., Dislocation following total hip arthroplasty (THA) is a common complication associated with substantial morbidity and increased health care expenditures. A 2009 study of more than 50 000 revision THAs found [...]

Background: Total hip arthroplasty (THA) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes. We systematically reviewed the contemporary literature to assess the 1) indications, 2) implant selection and long-term survivorship, 3) complication and reoperation rates and 4) radiographic and functional outcomes of primary THA in patients younger than 55 years. Methods: We searched the Embase and MEDLINE databases for English-language articles published between 2000 and 2018 that reported outcomes of primary THA in patients younger than 55 years with a minimum follow-up duration of 10 years. Results: Thirty-two studies reporting on 3219 THA procedures performed in 2434 patients met our inclusion criteria. The most common preoperative diagnoses were avascular necrosis (1044 [32.4%]), osteoarthritis (870 [27.0%]) and developmental dysplasia of the hip (627 [19.5%]). Modular implants (3001 [93.2%]), cementless fixation (2214 [68.8%]) and metal-on-polyethylene bearings (1792 [55.7%]) were frequently used. The mean 5- and 10-year survival rates were 98.7% and 94.6%, respectively. Data on survival beyond 10 years were heterogeneous, with values of 27%-99.5% at 10-14 years, 59%-84% at 15-19 years, 70%-77% at 20-24 years and 60% at 25-30 years. Rates of dislocation, deep infection and reoperation for any reason were 2.4%, 1.2% and 16.3%, respectively. The mean Harris Hip Score improved from 43.6/100 to 91.0/100. Conclusion: Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years. Future studies should evaluate the outcomes of THA in this population at 15-20 years' follow-up. Contexte : On effectue de plus en plus d'arthroplasties totales de la hanche (ATH) chez des patients qui ne sont pas âgés, malgré l'absence d'évaluation exhaustive des issues à long terme. Nous avons procédé à une revue systématique de la littérature récente pour analyser 1) les indications, 2) la sélection des implants et la survie à long terme, 3) les taux de complications et de réintervention, et 4) les résultats radiographiques et fonctionnels des ATH primaires chez les patients de moins de 55 ans. Méthodes : Nous avons interrogé les bases de données Embase et MEDLINE pour recenser les articles de langue anglaise publiés entre 2000 et 2018 qui faisaient état des issues d'ATH primaires chez des patients de moins de 55 ans suivis pendant au moins 10 ans. Résultats : Trente-deux études portant sur 3219 ATH effectuées chez 2434 patients répondaient à nos critères d'inclusion. Les diagnostics préopératoires les plus fréquents étaient la nécrose avasculaire (1044 [32,4%]), l'arthrose (870 [27,0%]) et la dysplasie développementale de la hanche (627 [19,5%]). Les implants modulaires (3001 [93,2%]), la fixation non cimentée (2214 [68,8%]) et le couple métal-polyéthylène (1792 [55,7%]) ont été fréquemment utilisés. Les taux de survie moyens à 5 et à 10 ans étaient de 98,7% et de 94,6%, respectivement. Les données sur la survie au-delà de 10 ans étaient hétérogènes, allant de 27% à 99,5% après 10 à 14 ans, de 59% à 84% après 15 à 19 ans, de 70% à 77% après 20 à 24 ans et de 60% après 25 à 30 ans. Les taux de dislocation, d'infection profonde et de réintervention, toutes causes confondues, étaient de 2,4%, de 1,2% et de 16,3%, respectivement. Le score de Harris moyen s'est amélioré, passant de 43,6/100 à 91,0/100. Conclusion : L'arthroplastie totale de la hanche chez les patients de moins de 55 ans donne des résultats fiables pour les 10 premières années après l'intervention. Les prochaines études devraient évaluer les issues de l'arthroplastie de la hanche dans cette population après 15 à 2 0 ans de suivi., Total hip arthroplasty (THA) reliably decreases pain and improves function and quality of life in patients with advanced hip disease at up to 25-30 years of follow-up. (1'2) Despite early [...]

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Objective: To investigate the feasibility and safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity., Methods: The clinical data of 120 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from March to December 2011 was analyzed retrospectively. In the video-assisted thoracoscopic surgery group, there were 60 patients [41 male and 19 female patients with aver age of (62 ± 7) years old] who underwent video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. In the routine thoracotomy group, there were 60 patients [39 male and 21 female patients with aver age of (62 ± 9) years old] who underwent routine thoracotomy esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. Operation time, intra-operative blood loss, postoperative total thoracic drainage in 3 days, total number of harvested lymph nodes, hospitalization, cost of hospitalization and complications were compared between the two groups., Result: The operations were carried out successfully in two groups. There was no perioperative death in all patients. There was no statistical difference in intra-operative blood loss, postoperative total thoracic drainage and cost of hospitalization between the two groups. Operation time of rideo-assisted thoracoscopic surgery group was significantly longer than that of thoracotomy group ((188 ± 38) minutes vs. (138 ± 50) minutes, t = 6.171, P = 0.000), but postoperative hospitalization was significantly lower ((14 ± 3) d vs. (18 ± 6) d, t = -4.093, P = 0.000) and total number of harvested lymph nodes was lower (17 ± 9 vs. 21 ± 11, t = -2.058, P = 0.042). There was significantly statistical difference in total postoperative main complication (25.0% vs. 48.3%, χ(2) = 7.033, P = 0.008). And postoperative incisional infection of VATE group patients was significantly lower than that of thoracotomy group patients (6.7% vs. 25.0%, χ(2) = 7.566, P = 0.006)., Conclusions: Video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity is technically feasible and safe, with minimized trauma and quick recovery. The recent result is satisfactory.