Dr. Nizam Published Articles
6. One-stage Exchange arthroplasty for periprosthetic hip and knee joint infection.
Question: How effective is one stage exchange arthroplasty in hip and knee joint infection?
Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function.
We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes.
Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements.
The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition.
7. The Bikini Hip replacement – Surgical Technique preserving Vessels and Deep Soft Tissues in Direct Anterior Approach Hip replacement
Surgical Technique describing the bikini Hip replacement
We provide a single surgeon experience of 100 cases describing the technique of directing anterior approach to the hip through a bikini incision (bikini hip replacement) without a traction table preserving the branches of the external circumflex lateral vessels, antero-medial capsule and adjacent labrum with limited dissection of the tensor fascia-lata.
At an average of 17.2 months (7.1 to 24.1), we found no evidence of groin pain or residual numbness in the lateral thigh. 1 patient had a haematoma due to increased anticoagulation that resolved spontaneously. All components were well placed with no dislocations or leg length discrepancies until the most recent follow up.
In conclusion, this soft tissue sparing technique using the bikini incision direct anterior approach is safe and led to no incidence of groin pain or lateral thigh numbness at the most recent follow-up.