Day 1 :
Athens Medical Group, Greece
Keynote: ALMIS anterolateral hip approach using a different table and legs position during femoral exposure; new surgical technique
Time : 10:00-10:45
Nikolaos Christodoulou is Chairman of Orthopedic Surgical Department in Iatriko Psychikou Clinic - Athens Medical Group, Greece. He has studied medicine in the University of Athens having succeeded the Greek National Scholarship IKY. He is specialized in Orthopedic Surgery at Asclepeion Orthopedic Hospital of Hellenic Red Cross. He has been Consultant Orthopedic Surgeon in Asclepeion Orthopedic Hospital at Athens in1983-1985 and received his PhD from University of Athens in 1985.
Two of best MIS hip approaches at least theoretically are the Röttinger muscles sparing Watson-Jones anterolateral approach in decubitus lateralis and the Pflüger at al MIS anterolateral approach in supine position but in our hands difficulties were present, especially during learning curve, to mobilize the femur without excessive superomedial capsule and external rotators e.g. piriformis and/or obturator internus release. External rotators release increases hip laxity and longer arthroplasty necks are usually used resulting to leg lengthening. In this new approach, only the gluteus minimus insertion tendon is temporary elevated and no branches of serious arteries e.g. of lateral circumflex artery are injured. The operating leg is not placed in extension but in 20° flexion, to avoid stress on abductors, as also in adduction and external rotation. The opposite leg is stabilized at the posterior leg support and the anterior is removed. The opposite leg in slight abduction and extension facilitates even more the femoral access. This approach may be used systematically in all primary or secondary osteoarthritis even in obese patients. In these cases, the skin incision may easily be extended without e.g. lateral cutaneous nerve of the thigh or deep femoral artery branches limitations of the anterior MIS approaches. The main restrictions are the severe posterior acetabular wall insufficiency or some high congenital dislocation cases. Gluteus minimus is strongly resutured at the end of the surgery at its normal place without consequences, the gait is immediate, hospitalization stay is normally 1-2 days and blood transfusion is very rare. Course in 725 patients operated with this new technique, in 342 of them using a short curved antirotation uncemented stem and a new generation threaded cup, is spectacular compared to the classic approaches and is more successful than our previously published less invasive and bloodless lateral MIS hip approach.
Central Clinical Hospital MSWiA Warsaw, Poland
Małgorzata Wisłowska is the Head of Department of Rheumatology and Internal Medicine of Central Clinical Hospital MSWiA Warsaw, Poland. She is a specialist in Internal Medicine, Rheumatology, Rehabilitation Medicine, Hypertension and the author of over 200 scientific papers and books. She has participated in numerous scientific meetings and is a promoter of 12 PhD theses. She took training at Guy and St. Thomas’ Hospitals in London, Charity Hospital in Berlin, Rheumatology Institutes in Prague and Moscow. In 2003, she started the Department of Internal Medicine and Rheumatology and in 2010 the Clinic of Internal Medicine and Rheumatology CSK MSW. She is a Professor at the Warsaw Medical University. Her research interests include “Internal medicine, rheumatology, rehabilitation medicine and hypertension”.
Granulomatosis with polyangiitis (GPA) is a rare systemic disease characterized by granuloma formation in small and medium sized vessels, inflammatory changes and necrotic tissue formation. Blood analysis reveals the presence of ANCA antibodies against proteinase 3 (PR3-ANCA). The etiopathogenesis of GPA notes the importance of IL-1, IL-12, IL-18 cytokines, TNF-alpha, INF-gamma and PR3-ANCA antibodies. Clinical features include dominant upper respiratory tract symptoms (inflammation of the nasal mucous, sinusitis, middle and inner ear inflammation, laryngitis and inflammation of the trachea). The most dangerous symptoms is subglottic stenosis, which should be treated immediately. Other symptoms include bronchitis and lung diseases (pulmonary nodules leading to cavity formation, pulmonary infiltrates and haemorrhage). Glomerulonephritis may lead to renal failure, Ocular changes (scleritis, episcleritis, iritis, corneal inflammation sometimes leading to its perforation, conjunctivitis, lacrimal duct changes, pseudo tumor in the orbit which may lead to blindness and inflammation of the opthic nerve) Myalgia, arthritis, purpura, subcutaneous skin nodule, ulcers, necrosis of digits, mononeuropathies, polyneuropathies, cranial nerve damage, ischemic stroke, cerebral hemorrhage, endocarditis, pericarditis, abdominal pain, diarrhea and gastrointestinal haemorrhage may occur. The clinical form of GPA present as local symptoms (upper or lower respiratory tract without systemic symptoms), early systemic disease (disease without compromising organ function and death), generalized systemic type (disease with organ dysfunction, creatinine concentration<500 umol/L), severe type (disease with multiorgan failure, creatinine concentration>500 umol/L), resistant type (disease progression despite treatment with glucocorticosteroids and cyclophosphamide). Treatment of local symptoms and early systemic disease includes immunosuppressive drugs such as methotrexate or azathioprine with medium dose of glucocorticosteroids. The generalized systemic type, resistant type and severe type of disease is treated using high doses of glucocorticosteroids and cyclophosphamide administered parenterally. In rapidly progressive glomerulonephritis, plasmapheresis is considered. A new treatment regime using rituximab in doses of 375 mg/m2 once a week for four weeks is suitable.