Operative treatment of congenital hip osteoarthritis with high hip luxation (Crowe type IV)

OBJECTIVE The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA). INDICATIONS Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality. CONTRAINDICATIONS Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients. SURGICAL TECHNIQUE With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest. POSTOPERATIVE MANAGEMENT During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing. RESULTS From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.

Paisajes después de la batalla

Sobre la base de un riguroso y sistemático análisis del dossier genético de la novela Paisajes después de la batalla (borradores autógrafos, recortes de prensa, sinopsis), conservado en la Diputación Provincial de Almería, Bénédicte Vauthier se adentra en el taller de escritura de Juan Goytisolo en un estudio genético verdaderamente pionero en las letras hispánicas contemporáneas peninsulares. Después de presentar el estado de los archivos y la peculiar manera de escribir de J. Goytisolo, B. Vauthier vuelve sobre la composición original de Paisajes después de la batalla, analiza cómo el autor incorporó estilísticamente el material ajeno que entró en la composición de la obra (recortes de prensa) o la informó implícita o explícitamente (intertextualidad de Gustave Flaubert, Walter Benjamin, Karl Kraus, Leila Sebbar, Lewis Carroll). Finalmente, en la óptica de una «poética de transición entre estados», B. Vauthier se interroga sobre el sentido de la supresión que Goytisolo operó en la nueva edición de su obra (2006), que se vuelve a publicar aquí respetando esta decisión de «poda». Ilustrados por numerosos facsímiles y autógrafos, los preliminares vienen seguidos de una edición crítica de la novela que permite la localización exacta