Early Complications of using Dual Mobility Cup in Total Hip Arthroplasty. A Systematic Review

Background Total hip arthroplasty (THA) is considered one of the most successful surgical procedures providing pain relief and improvement of function in patients with end-stage hip arthritis that does not respond to non-operative treatments. As health care continues to improve and life expectancy increases, the demand for total joint replacement will grow to reflect this more active, aging population. Objectives This study aims to review early complications of dual mobility cup arthroplasty. The objective is to perform a systematic review of early complications of dual mobility cup arthroplasty for primary and revision cases. Methodology Types of studies we will include randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, and we will exclude case reports, case series studies, cross sectional studies, non English studies. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: THA, Dual mobility cup, complications, intraprosethetic dislocation. Results Early complication rate in dual mobility cups is significantly higher in revision cases compared to primary cases, with the exception of IPD which was significantly lower in revision cases. Early complication rate of conventional THA was significantly higher than both primary and revision dual mobility cups. Conclusion Dual mobility THAs are a good alternative to traditional bearing surfaces with long survivorship and low rates of instability after primary and revision THA. The rate of complications which are unique to the procedure, including intraprosthetic dislocation, is relatively low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to further evaluate the use of dual mobility in primary and revision THA.

Rectovaginal fistula: An early complication of radiotherapy in a sexagenarian with cervical cancer

A 62-year-old Nigerian woman was admitted on account of cervical carcinoma Stage IV and was requested to undergo radiotherapy and chemotherapy. Six weeks after commencing this treatment she starting passing feces involuntarily through the vagina. Imaging studies revealed a high sited, medium sized, and rectovaginal fistula (RVF). RVFs have been documented as a late complication of radiotherapy for any gynecological malignancy but it occurred earlier in this patient. A preliminary surgical procedure, a sigmoid-ostomy, was performed successfully and a definitive surgery, a sigmoido-rectal anastomosis, was planned to be done in 18 months after the diagnosis of the RVF but the patient died shortly after the first procedure. The present case indicates that a RVF can occur as an early complication of radiotherapy even when it presents with mild symptoms.

Early complication of diverting ileostomy. Laparoscopic approach.

Resumen Presentamos la imagen correspondiente a una complicación temprana de una ileostomía en asa. Se trata de una paciente de 25 años a la que se ha realizado una colectomía total con reconstrucción mediante anastomosis ileoanal en J por vía laparoscópica e ileostomía de protección, en el contexto de una neoplasia rectal a 5 centímetros del margen anal con neadyuvancia previa y una poliposis juvenil con múltiples pólipos irresecables en el colon ascendente y transverso. Se confecciona ileostomía de protección en punto previamente marcado en consulta de estomoterapia. La paciente presenta cuadro oclusivo con ileostomía no funcionante en el postoperatorio inmediato y distensión abdominal así como elevación de PCR en control analítico, por lo que se decide reintervención quirurgica mediante abordaje laparoscópico apreciándose torsión ("twister") del asa de la ileostomía, se desinserta la ileostomía y se vuelve a fijar a la piel correctamente orientada. Las ileostomías no están exentas de complicaciones con una morbilidad que puede alcanzar el 70% en algunas series1 siendo la obstrucción intestinal de un 7% 2 y se debe ser muy cuidadosos en su confección ya que al ser el último paso de la cirugía puede dar lugar fallos por pérdida de concentración. Del mismo modo el abordaje laparoscópico se muestra como eficaz y seguro en este tipo de reintervenciones.