Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications.

Total hip arthroplasty (THA) is currently considered the most effective treatment for end-stage hip osteoarthritis (OA). The surgery can be performed via a number of different approaches, including direct anterior (DAA; Smith–Petersen; Hueter), anterolateral (ALA; Watson–Jones), direct lateral (LA; Bauer), posterior (PA; Kocher–Langenbeck), and posterolateral (PLA). There is still a dispute over the optimal technique. The aim of this systematic review was to assess how different surgical approaches toward a THA influence the prosthesis elements’ positioning. We conducted a literature search of Scopus, ScienceDirect, PubMed, Embase, and The Cochrane Library. We evaluated studies in terms of the first author’s name, country, publication year, type of surgical approach being compared to the direct anterior approach, any significant differences at baseline, sample size, and radiographic analysis. A subanalysis of each approach in comparison to the DAA revealed differences in terms of all analyzed implant positioning radiographic parameters. There is still an insufficient number of randomized controlled studies that include radiological analyses comparing THRs (total hip replacements) performed using DAA with other approaches. Implant placement is a crucial step during a THR and surgeons must be aware that the approach they use might impact their judgment on angles and spaces inside the joint and thus alter the implant positioning.

Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic–assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher’s exact, Kruskal–Wallis and Dwass–Steel–Crichtlow–Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.

Background Total hip arthroplasty (THR) is considered as the most effective available method of treatment of end-stage hip osteoarthritis (OA). This surgery can be performed via many different approaches. One of the newly developed technique is called direct anterior approach (DAA). It gains popularity and recognition as the least traumatic to the soft tissues, thus quickening rehabilitation and improving joint stability in the early postoperative period. There are no systematic reviews covering this subject in terms of potential differences in radiological prosthesis placement, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. The objective of our study was to systematically collect and review available data from randomized-controlled trials (RCTs) regarding radiographic assessment of prosthesis placement after total hip arthroplasty using direct anterior approach compared to other common approaches.Methods A systematic review of randomized controlled trials (RCTs) will be conducted. SciFinder, Scopus, ScienceDirect, PubMed, Embase, Clinical Key and The Cochrane Library databases will be searched without restriction to date up to June 2020. Primary outcomes will include measurements related with the radiological analysis of trials comparing use of DAA to other approaches used for THR, containing at least two of the following: femoral stem alignment, mean radiographic cup inclination, mean radiographic cup anteversion, mean radiographic cup abduction, position in Lewinnek's safe zone. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for RCTs. Discussion This systematic review will provide missing information regarding influence of differences between DAA and other surgical approaches in total hip replacement on prosthesis implants placement in case of femoral stem and cup. This may result in improving knowledge and awareness of surgeons, improving patients satisfaction and functional outcome and lowering the risk of hip dislocations and other complications. Trial registration International Registration of Systematic reviews (PROSPERO) number CRD42019122675

Background and Objectives: The safe zone in total hip replacement was introduced many years ago. Its aim was to provide guidelines for orthopedic surgeons in order to avoid complications such as instability. With the growing interest in spinopelvic alignment, some new insights suggest that the safe zone is an obsolete concept. This study aims to show that, even outside the safe zone, the effect of total hip replacement can be satisfactory. This could be used as preliminary study for an analysis of a larger group. Materials and Methods: Fifty-nine consecutive patients with end-stage osteoarthritis treated by total hip replacement were enrolled into the study and divided into two groups: inside the safe zone and outside the safe zone. A physical examination during postoperative visits was performed; the range of movement was measured using a goniometer; and the HHS and VAS were taken to measure functional outcomes and pain, respectively. An analysis of the radiological outcomes was performed. Results: There was no significant difference in regard to changes in total offset, pain, HHS and other complications. There were no signs of instability among patients during the follow-up. Conclusions: The results of this study show that the “safe zone” is a more complicated term that was previously thought. A proper soft tissue balance and spinopelvic alignment could be factors that change the “safe zone” for each patient and make it more individual.

BackgroundTotal hip arthroplasty (THR) is considered as the most effective available method of treatment of end-stage hip osteoarthritis (OA). This surgery can be performed via many different approaches. One of the newly developed technique is called direct anterior approach (DAA). It gains popularity and recognition as the least traumatic to the soft tissues, thus quickening rehabilitation and improving joint stability in the early postoperative period. There are no systematic reviews covering this subject in terms of potential differences in radiological prosthesis placement, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. The objective of our study was to systematically collect and review available data from randomized-controlled trials (RCTs) regarding radiographic assessment of prosthesis placement after total hip arthroplasty using direct anterior approach compared to other common approaches.MethodsA systematic review of randomized controlled trials (RCTs) will be conducted. SciFinder, Scopus, ScienceDirect, PubMed, Embase, Clinical Key and The Cochrane Library databases will be searched without restriction to date up to June 2020. Primary outcomes will include measurements related with the radiological analysis of trials comparing use of DAA to other approaches used for THR, containing at least two of the following: femoral stem alignment, mean radiographic cup inclination, mean radiographic cup anteversion, mean radiographic cup abduction, position in Lewinnek's safe zone. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for RCTs. DiscussionThis systematic review will provide missing information regarding influence of differences between DAA and other surgical approaches in total hip replacement on prosthesis implants placement in case of femoral stem and cup. This may result in improving knowledge and awareness of surgeons, improving patients satisfaction and functional outcome and lowering the risk of hip dislocations and other complications. Trial registrationInternational Registration of Systematic reviews (PROSPERO) numberCRD42019122675