Leiomyoma of the female urethra is a very rare entity. A case of leiomyoma of the female urethra arising from the anterior lip of the external urethral meatus in a forty-year-old female is presented. The presenting symptoms were awareness of a mass and recurrent urinary tract infection. The mass was resected surgically and confirmed as a leiomyoma histologically.
Female* ; Humans ; Leiomyoma* ; Lip ; Urethra* ; Urinary Tract Infections

PURPOSE: The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. METHODS: Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. RESULTS: Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. CONCLUSIONS: This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.
Artificial Cells ; Bone Regeneration ; Bone Substitutes ; Calcium ; Durapatite ; Humans ; Hydroxyapatites ; Male ; Maxillary Sinus ; Oligopeptides ; Osteogenesis ; Rabbits

PURPOSE: In general, the results and prognosis of surgical treatment in dialysis patients are poor compared to patients with normal kidney function. This study analyzes the complications in chronic renal failure patients who underwent primary hip arthroplasty for hip fractures and arthropathy. Orthopaedic complications and medical complications were analyzed for a consequential difference. MATERIALS AND METHODS: Between 2003 and 2008, 38 dialysis patients (40 cases) with chronic renal failure were enrolled with 24 cases of bipolar hemiarthroplasty and 16 cases of total hip arthroplasty. Types and rates of orthopaedic and medical complications were investigated. Patients were classified according to age, gender, duration of dialysis and diabetes mellitus status. Complications were analyzed for each group. RESULTS: Complications occurred in 15 patients (overall complication rate: 37.5%). Eight patients were died within 1 year (mortality: 20%). Gender and duration of dialysis were not correlated to number of complications. However, there were significant differences according to age (p=0.014) and having diabetes (p=0.026). With regard to mortality, there was no significant difference according to the above classification. CONCLUSION: Patients on hemodialysis have a high risk of complications after primary hip arthroplasty, especially in elderly patients and diabetic patients. Therefore, we require a full disclosure before recommending hip arthroplasty surgery in dialysis patients, and close postoperative care in patients undergoing dialysis.
Aged ; Arthroplasty ; Diabetes Mellitus ; Dialysis ; Disclosure ; Hemiarthroplasty ; Hip ; Hip Fractures ; Humans ; Kidney ; Kidney Failure, Chronic ; Postoperative Care ; Prognosis ; Renal Dialysis

Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.
Adult ; Arthroplasty, Replacement, Hip/*methods ; Ceramics/*therapeutic use ; Female ; Hip Prosthesis ; Humans ; Polyethylene/*therapeutic use ; *Prosthesis Failure

PURPOSE: In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23]) MATERIALS AND METHODS: We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). RESULTS: There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). CONCLUSION: There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH Arthroplasty ; Classification ; Extremities ; Femur* ; Fracture Healing ; Hemiarthroplasty* ; Hip Fractures* ; Hip* ; Humans ; Retrospective Studies

Background: Hip fracture surgery is associated with blood loss, which may lead to adverse patient outcomes. The hemoglobin level declines gradually in most hip fracture cases involving femoral neck fractures and intertrochanteric fractures. It decreases further after hip fracture surgery due to perioperative bleeding. We developed a protocol, which avoids transfusion in hip fracture surgery, and reviewed the hemodynamic outcomes of patients with hemoglobin less than 10 g/dL without transfusion. Methods: From 2014 to 2019, we retrospectively recruited 34 patients with hip fractures and a hemoglobin level less than 10 g/dL, who refused to undergo transfusion. There were 19 patients with femoral neck fractures and 15 patients with intertrochanteric fractures. Our patient blood management (PBM) protocol involving 4,000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) was applied to all included patients. Intraoperatively, a cell saver and tranexamic acid were used. Postoperatively, the protocol was maintained until the patients’ hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications, and hemodynamic changes. Results: Nineteen patients with femoral neck fractures underwent bipolar hemiarthroplasty and 15 patients with intertrochanteric frac tures underwent internal fixation with a cephalomedullary nail. The mean hemoglobin level was 8.9 g/dL (range, 7.3–9.9 g/dL) pre operatively, 7.9 g/dL (range, 6.5–9.3 g/dL) immediately postoperatively, 7.7 g/dL (range, 4.3–9.5 g/dL) on postoperative day 1, 7.4 g/dL (range, 4.2–9.4 g/dL) on postoperative day 3, 8.1 g/dL (range, 4.4–9.7 g/dL) on postoperative day 5, 8.5 g/dL (range, 4.5–9.9 g/dL) on post­operative day 7, and 9.9 g/dL (range, 5.7–11.1 g/dL) on postoperative day 14. The average intraoperative bleeding was 206.2 ± 78.7 mL. There was no case associated with complications of anemia. Conclusions Hip fracture surgery in patients with hemoglobin less than 10 g/dL was feasible without the need for transfusion using our PBM protocol in 34 patients. Using this protocol, the operation was conducted safely despite the anemic condition of patients with fractures whose hemoglobin was less than 10 g/dL.

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.
Anemia ; Arthroplasty* ; Blood Transfusion ; Consensus* ; Erythropoiesis ; Fibrinolysis ; Hemorrhage ; Hip* ; Hospitalization ; Humans ; Incidence ; Iron ; Lysine ; Tranexamic Acid

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Hip* ; Humans ; Pain Management* ; Peripheral Nerves ; Quality of Life ; Rehabilitation

Although the incidence of sciatic nerve palsy following total hip arthroplasty is low, this complication can cause devastating permanent nerve palsy. The authors experienced a case of sciatic nerve palsy caused by ruptured and contracted external rotator muscles following total hip arthroplasty in a patient suffering from osteonecrosis of the femoral head. We report this unusual case of sciatic nerve palsy with a review of the literature.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Head ; Humans ; Incidence ; Muscles* ; Osteonecrosis ; Paralysis ; Sciatic Neuropathy*

Internal impingement syndrome is characterized by the posterior shoulder pain when the arm is abducted and external rotated, and articular partial rotator cuff tear with posterosuperior labral fraying in throwing athletes. Osteochondral lesion of humeral head as an associated lesion is reported in some cases but, not considered to be a main origin of the symptoms. We found the similar features of osteochondral lesion on humeral head in three cases of internal impingement syndrome irrespective of conservative treatment for over three months and report good results obtained from arthroscopic debridement and microfracturing for these lesions with a review of the literatures.
Arm ; Athletes ; Cartilage Diseases ; Debridement ; Humans ; Humeral Head* ; Rotator Cuff ; Shoulder Pain ; Shoulder*