Issue: October 2017
October 03, 2017
3 min read

EFORT Annual Congress in Barcelona: Experts’ advice on intraoperative hip arthroplasty complications

Issue: October 2017
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Are you looking for answers on how to deal with intraoperative complications during hip surgery? Our upcoming 2018 meeting has scheduled an Interactive Expert Exchange session that addresses all the key problems around the frequent challenges of hip replacement.

Total hip arthroplasty is one of the most common, successful and cost-effective orthopedic reconstructive procedures performed. Today, modern total hip arthroplasty (THA) regularly leads to better pain relief, excellent functional outcome for the patient and long-lasting implant survival. Therefore, specific training for this medical procedure has become essential in most of the European orthopedic residency programs. However, despite the surgeon’s experience and a good preoperative planning, problems still arise in the OR.

Incidence of intraoperative complications following primary and revision THA strongly depends on the nature of the problem and on a multitude of risk factors. This Interactive Expert Exchange (IEE) session guides the attendees through the careful and needed considerations to prevent and overturn all potential pitfalls encountered at each stage of these two surgical procedures.

Friday 1 June 2018 | 10:15 to 12:30
How to Prevent, Recognize and Solve Intraoperative Complications?

Introduction & Conclusions
George Macheras (Greece) - Fares Haddad (United Kingdom)

Questions & Presentations

  • Leg Length Discrepancy | Luigi Zagra (Italy)
  • Intraoperative Periprosthetic Fractures | Carsten Perka (Germany)
  • Importance of Soft-Tissue Management & Prevention of Instability | George Babis (Greece)
  • Strategies to Minimize Intraoperative Blood Loss - Neurovascular Injuries | Jean-Noël Argenson (France)

Clinical Cases – Discussion
Provocateurs: George Macheras (Greece) & Fares Haddad (United Kingdom)

There are several well-known tips and tricks to consider prior to the patient listing for surgery to avoid usual complications. In any case, early recognition of the problem will obviously prevent significant long-term consequences for the patient and help to achieve a good operative outcome despite an atypical path.

The critical issues to consider nowadays include risk assessment for medical comorbidities and for modifiable risks factors of infection, as well as evaluation of the tangible risks of instability, periprosthetic fractures and of predisposing factors for other complications, such as leg length inequality. A careful examination of each patient’s medical history will identify both intrinsic and extrinsic factors that can be addressed in each case. In most instances, good preoperative planning, the availability of the appropriate equipment, technical support and a scrupulous execution will lead to an uneventful outcome.

In recent years, there has been a dramatic evolution in the attempts to reduce the instability burden and the understanding of the periprosthetic fractures epidemic has also greatly improved. Current orthopedic practitioners manage these problems through cautious implant choice and technique. A constant level in the surgeon’s attention to detail will also reduce intraoperative and perioperative complications, such as dramatic blood loss, leg length inequality, nerve injury and subsequent thromboembolism.


Challenging complications

In elderly patients, periprosthetic fractures with osteoporotic bone are usually the most difficult and challenging complication. An accurate preoperative estimation of the bone quality, the unambiguous classification of the fracture and a detailed planning are essential to overcome this specific difficulty.

Widespread pre-existing medical conditions increasing the risk of intraoperative complications include obesity, comorbidities, poor nutritional status, use of corticosteroids and several types of inflammatory disorders. For instance, when severe predisposing factors, such as obesity and coagulation disorders, are identified, prevention of thromboembolic events needs to be anticipated for surgery.

During this session, presentations will give additional recommendations on the precautions to take against neurovascular bundle around the hip joint, as well as endorse guidelines to manage nerve injuries. Questions regarding minimally invasive vs. conventional approaches, the use of short-stem vs. long-stem femoral components, and the choice between cemented or uncemented fixation will be answered to clarify how to handle intraoperative complications directly linked to the implant itself. Indeed, instability during surgery should be managed by using the proper size and type of implants, and by restoring hip biomechanics and soft tissue balance.

IEE Barcelona Banner

Interactive format supports decision-making

The format of this exchange, including lectures, open debates and case presentations, will lead to a deep-seated appreciation of how to offer optimal individualized primary and revision hip arthroplasty and to prevent all kinds of complications and improve the general outcome. The chosen group of highly experienced reconstruction surgeons can influence the decision-making of any attendee’s current practice.

The IEEs are paying sessions and pre-registration is mandatory (up to a maximum of 200 participants) on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the congress. All details to sign-up will be available on our registration platform as of January 2018. Do not forget to visit our 2018 congress website regularly.

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