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Cartilage tissue has a very limited ability to regenerate. Symptomatic cartilage lesions are currently treated by various cartilage repair techniques. Multiple treatment techniques have been proposed in the last 30 years. Nevertheless, no single technique is accepted as a gold standard. Minced cartilage implantation is a newer technique that has garnered increasing attention. This procedure is attractive because it is autologous, can be performed in a single surgery, and is therefore given it is cost-effective. This narrative review provides an overview of the biological potential of current cartilage regenerative repair techniques with a focus on the translational evidence of minced cartilage implantation.
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Produtos Biológicos , Cartilagem Articular , Humanos , Condrócitos , Cartilagem Articular/cirurgia , Cartilagem Articular/patologia , Regeneração , Transplante AutólogoRESUMO
OBJECTIVES: Cardiac tumors represent a rare and heterogeneous pathological entity, with a cumulative incidence of up to 0.02%. Gender was previously reported to influence outcomes after tumor surgery. This study aimed to investigate for gender-related differences in outcomes after cardiac surgery. METHODS: Between 2009 and 2021, 95 male and 88 female patients underwent surgery for tumor extirpation in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by (immune-)histopathological analysis. RESULTS: There were no significant differences in baseline characteristics and survival. Myxoma was the most common tumor type overall and was more diagnosed in women (n = 36 vs. n = 62, p ≤ 0.001). Sarcoma was the most common malignant tumor type (n = 5). Tumor location at the atrial septum was more likely in women (n = 26 vs. n = 16, p = 0.041), whereas ventricular localization was more common in male patients (n = 20 vs. n = 7, p = 0.001). Minimally invasive tumor extirpation was significantly more often performed in women, and in-hospital stay was shorter in female patients. CONCLUSION: The localization and dignity of cardiac tumors differ between genders, not affecting survival. Surgical tumor extirpation remains the gold standard of treatment for cardiac tumors in both genders as it is highly effective and associated with good long-term survivorship.
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Procedimentos Cirúrgicos Cardíacos , Neoplasias Cardíacas , Mixoma , Sarcoma , Feminino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Mixoma/diagnóstico , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgia , Resultado do TratamentoRESUMO
Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to significant improvement in selected patients' survival rates. Gender-related differences might impact the outcome of therapeutic measures. Therefore, we sought to investigate patients with eCPR at our interdisciplinary extracorporeal membrane oxygenation center regarding sex-related differences with the view to potentially adjusting current selection criteria. From January 2016 to December 2019, 71 patients underwent eCPR at our institution. Data before eCPR and early outcome parameters were analyzed comparing male and female patients. The cohort analyzed consisted of 60 male (84%) and 11 female (15%) patients. Comparing both groups, male patients significantly more frequently suffered out-of-hospital cardiac arrest (68% male vs. 36% female, P = .04), whereas female patients were associated with more in-hospital cardiac arrest (32% male vs. 64% female, P = .04). Creatinine levels differed significantly (1.5 (1.1;2.1) mg/dL in male vs. 1.0 (0.7;1.5) mg/dL in female patients, P = .03). Also, several hepatic parameters showed a significant difference between the groups: aspartate aminotransferase 423 (249;804) U/L in male vs. 115 (61;408) U/L in female patients, P = .01; alanine aminotransferase 174 (102;446) U/L in male vs. 86 (36;118) U/L in female patients, P = .01). Renal failure requiring hemodialysis occurred more frequently in men than in women (P < .01). There is a significant effect of male sex regarding renal failure with subsequent continuous venovenous hemodialysis (CVVH) (R2 = 0.11, ANOVA P = .01, 95% CI = -0.79--0.079). However, in-hospital mortality was comparable between the groups (78% in male vs. 72% in female patients, P = .68). Our retrospective study showed several gender-related differences associated with different cardiac arrest scenarios. Male sex was associated with a significantly higher risk for renal failure requiring CVVH. Survival rates were comparable between the groups. Further investigations should include gender in the evaluation of risk stratification for eCPR-related complications to further improve selection criteria for this demanding therapy.
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Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Parada Cardíaca/terapia , Insuficiência Renal/epidemiologia , Adulto , Idoso , Reanimação Cardiopulmonar/estatística & dados numéricos , Creatinina/sangue , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Humanos , Testes de Função Hepática/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Insuficiência Renal/sangue , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of this study is to compare biomechanical features of different devices used in clinical routine for temporary epiphysiodesis (eight-Plate® and FlexTackTM). The tested implants were divided into four different groups (eight-Plate® vs. FlexTackTM for lateral and anterior implantation) á 10 samples for testing implanted eight-Plate® vs. FlexTackTM in fresh frozen pig femora for maximum load forces (Fmax) and axial physis distance until implant failure (lmax). A servo hydraulic testing machine (858 Mini Bionix 2) was used to exert and measure reproducible forces. Statistical analyses tested for normal distribution and significant (p < 0.05) differences in primary outcome parameters. There were no significant differences between the eight-Plate® lateral group and the FlexTackTM lateral group for neither Fmax (p = 0.46) nor lmax (p = 0.65). There was a significant higher Fmax (p < 0.001) and lmax (p = 0.001) measured in the eight-Plate® group compared to the FlexTackTM group when implanted anteriorly. In anterior temporary ephiphysiodesis, eight-Plate® demonstrated superior biomechanical stability. At this stage of research, there is no clear advantage of either implant and the choice remains within the individual preference of the surgeon.
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Substitutos Ósseos/química , Epífises/química , Fêmur/cirurgia , Próteses e Implantes , Desenho de Prótese , Animais , Fenômenos Biomecânicos , Placas Ósseas , Fêmur/efeitos dos fármacos , Teste de Materiais , Estresse Mecânico , Suínos , Distribuição TecidualRESUMO
SARS-CoV-2 (COVID-19) infections have been recently shown to be associated with a high rate of thromboembolic events due to pro-coagulative mechanisms that have not yet been fully understood. This paper reports on a 55-year-old female COVID-19 patient with severe ARDS and pulmonary embolism (PE) complicated by cardiogenic shock after 12 days of hospitalization under initial prophylactic anticoagulation with low molecular weight heparin (LMWH). An ultima-ratio va (veno-arterial) ECMO implantation and subsequent rapid upgrade to vvaECMO due to insufficient oxygenation was performed. The patient developed severe coagulopathy with intrapulmonary bleeding. The present report aims to highlight and discuss the pros and cons of various anticoagulation strategies in COVID-19 patients focusing on current scientific debates to address this frequently observed complication in the current situation worldwide.
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COVID-19 , Oxigenação por Membrana Extracorpórea , Embolia Pulmonar , Anticoagulantes/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , SARS-CoV-2RESUMO
BACKGROUND: Custom-made acetabular components (CMAC) are one established method to address severe acetabular bone defects. Monoflanged CMAC may represent an advantageous alternative to establish triflanged CMAC as they promote better primary stability through metallic defect reconstruction and thus anatomic restoration of the center of rotation (COR). METHODS: Fifty-eight consecutive (21 triflanged and 37 monoflanged) CMAC were evaluated for overall survival, reasons for revision, radiological restoration of COR, and clinical outcome parameters. RESULTS: There were no significant differences between both design types regarding overall survival, revision rates, Harris Hip Score, or visual analog scale (pain) score at latest follow-up (mean, 56.3 ± 28.7 months). Triflanged CMAC showed a significant lateralization (P ≤ .001) and cranialization (P = .003) of the COR compared to the contralateral side. Monoflanged CMAC restored the anatomic COR. Reasons for revision surgery and explantation were periprosthetic joint infection (n = 12) and aseptic loosening (n = 2) without significant differences between both groups. CONCLUSION: Monoflanged CMAC demonstrate similar clinical outcome parameters and survival rates as triflanged CMAC but superior biomechanical features and represent therefore a solid alternative treatment option and implant design.
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Artroplastia de Quadril , Prótese de Quadril , Acetábulo/cirurgia , Cultura , Seguimentos , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Mesenchymal stromal cells (MSC) harvested in different tissues from the same donor exhibit different phenotypes. Each phenotype is not only characterized by a certain pattern of cell surface markers, but also different cellular functionalities. Only recently were different harvesting and processing techniques found to contribute to this phenomenon as well. This study was therefore set up to investigate proteomic and functional properties of human bone marrow-derived MSCs (hBM-MSC). These were taken from the same tissue and donor site but harvested either as aspirate or bone chip cultures. Both MSC populations were profiled for MSC markers defined by the International Society for Cellular Therapy (ISCT), MSC markers currently under discussion and markers of particular interest. While classic ISCT MSC markers did not show any significant difference between aspirate and outgrowth hBM-MSCs, our additional characterization panel revealed distinct patterns of differentially expressed markers. Furthermore, hBM-MSCs from aspirate cultures demonstrated a significantly higher osteogenic differentiation potential than outgrowth MSCs, which could be confirmed using a transcriptional approach. Our comparison of MSC phenotypes obtained by different harvesting techniques suggests the need of future standardized harvesting, processing and phenotyping procedures in order to gain better comparability in the MSC field.
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Biomarcadores/metabolismo , Células-Tronco Mesenquimais/citologia , Proteômica/métodos , Manejo de Espécimes/métodos , Adipogenia , Biópsia por Agulha , Técnicas de Cultura de Células , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Condrogênese , Humanos , Células-Tronco Mesenquimais/metabolismo , Osteogênese , FenótipoRESUMO
INTRODUCTION: Cartilage regeneration and restoration is a major topic in orthopedic research as cartilaginous degeneration and damage is associated with osteoarthritis and joint destruction. This systematic review aims to summarize current research strategies in cartilage regeneration research. MATERIALS AND METHODS: A Pubmed search for models investigating single-site cartilage defects as well as chondrogenesis was conducted and articles were evaluated for content by title and abstract. Finally, only manuscripts were included, which report new models or approaches of cartilage regeneration. RESULTS: The search resulted in 2217 studies, 200 of which were eligible for inclusion in this review. The identified manuscripts consisted of a large spectrum of research approaches spanning from cell culture to tissue engineering and transplantation as well as sophisticated computational modeling. CONCLUSIONS: In the past three decades, knowledge about articular cartilage and its defects has multiplied in clinical and experimental settings and the respective body of research literature has grown significantly. However, current strategies for articular cartilage repair have not yet succeeded to replicate the structure and function of innate articular cartilage, which makes it even more important to understand the current strategies and their impact. Therefore, the purpose of this review was to globally summarize experimental strategies investigating cartilage regeneration in vitro as well as in vivo. This will allow for better referencing when designing new models or strategies and potentially improve research translation from bench to bedside.
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Cartilagem Articular , Regeneração , Engenharia Tecidual , Animais , Pesquisa Biomédica , Humanos , Modelos BiológicosRESUMO
BACKGROUND: The application of expandable titanium-cages has gained widespread use in vertebral body replacement for indications such as burst fractures, tumors and infectious destruction. However, torque forces necessary for a satisfactory expansion of these implants and for subsidence of them into the adjacent vertebrae are unknown within the osteoporotic spine. METHODS: Six fresh-frozen human, osteoporotic, lumbar spines were dorsally instrumented with titanium implants (L2-L4) and a partial corpectomy of L3 was performed. An expandable titanium-cage was inserted ventrally and expanded by both residents and senior surgeons until fixation was deemed sufficient, based on haptic feedback. Torque forces for expansion were measured in Nm. Expansion was then continued until cage subsidence occurred. Torque forces necessary for subsidence were recorded. Strain of the dorsal rods during expansion was measured with strain gauges. FINDINGS: The mean torque force for fixation of cages was 1.17 Nm (0.9 Nm for residents, 1.4 Nm for senior surgeons, p = .06). The mean torque force for subsidence of cages was 3.1 Nm (p = .005). Mean peak strain of the dorsal rods was 970 µm/m during expansion and 1792 µm/m at subsidence of cages (p = .004). INTERPRETATION: The use of expandable titanium-cages for vertebral body replacement seems to be a primarily safe procedure even within the osteoporotic spine as torque forces required for subsidence of cages are nearly three times higher than those needed for fixation. Most of the expansion load is absorbed by straining of the dorsal instrumentation. Rod materials other than titanium may alter the torque forces found in this study.
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Fusão Vertebral , Titânio , Humanos , Corpo Vertebral , Torque , Vértebras Lombares/cirurgia , Próteses e ImplantesRESUMO
BACKGROUND: While predictors for postoperative survival in spine tumour patients have been identified, there is limited evidence for predictors of postoperative Quality of Life (QoL), pain and functional outcome. METHODS: One hundred and fifty-three consecutive patients, who had undergone surgery for symptomatic spinal metastases between June 2016 and April 2019, were interviewed preoperatively and during follow-ups at three, six and 12 months using the EQ-5D-3L, COMI, and ODI questionnaires. Differences in means exceeding the specific Minimal Clinically Important Difference (MCID) values were considered clinically significant. RESULTS: Thirty-three percent of the patients were reported dead after 12 months. Only one metastasis compared to multiple metastases has 7.9 the Odds for an improved EQ-5D-3L score at three months. No neoadjuvant metastatic irradiation has 6.8 the Odds for the improvement at that time against performed radiation. A preoperative ODI score between 50.1 and 100 has 22.0 times the odds compared to the range from 0 to 50 for an improved EQ-5D-3L after three months, and 12.5 times the odds in favour of improved COMI after three months, and 13.6 times the odds for improvement of ODI at the three-month follow-up. A preoperative COMI score ranging from 5.0 to 10 has 21 times the odds of a COMI between 0 and 5 for an improved EQ-5D-3L score and 11 times the odds for an improved ODI after 12 months. Other predictors showed no statistically significant improvement. CONCLUSION: An improvement in QoL, pain and spinal function after 12 months can be predicted by a subjective preoperative poor health condition. Impaired spinal function before surgery, a singular metastasis and no previous irradiation is predictive of improved spinal function and quality of life three months after surgery.
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Neoplasias , Qualidade de Vida , Humanos , Resultado do Tratamento , Dor Pós-OperatóriaRESUMO
Hip arthroplasty effectively treats advanced osteoarthritis and is therefore entitled as "operation of the 20th century." With demographic shifts, the USA alone is projected to perform up to 850â¯000 arthroplasties annually by 2030. Many implants now feature a ceramic head, valued for strength and wear resistance. Nonetheless, a fraction, up to 0.03% may fracture during their lifespan, demanding complex removal procedures. To address this, a radiation-free, fluorescence-based image-guided surgical technique is presented. The method uses the inherent fluorescence of ceramic implant materials, demonstrated through chemical and optical analysis of prevalent implant types. Specifically, Biolox delta implants exhibited strong fluorescence around 700 nm with a 74% photoluminescence quantum yield. Emission tails are identified extending into the near-infrared (NIR-I) biological transparency range, forming a vital prerequisite for the label-free visualization of fragments. This ruby-like fluorescence could be attributed to Cr within the zirconia-toughened alumina matrix, enabling the detection of even deep-seated millimeter-sized fragments via camera-assisted techniques. Additionally, fluorescence microscopy allowed detection of µm-sized ceramic particles, enabling debris visualization in synovial fluid as well as histological samples. This label-free optical imaging approach employs readily accessible equipment and can seamlessly transition to clinical settings without significant regulatory barriers, thereby enhancing the safety, efficiency, and minimally invasive nature of fractured ceramic implant removal procedures.
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Prótese de Quadril , Cirurgia Assistida por Computador , Fluorescência , Cerâmica , ZircônioRESUMO
BACKGROUND AND OBJECTIVES: Surgical treatment is an integral component of multimodality management of metastatic spine disease but must be balanced against the risk of surgery-related morbidity and mortality, making tailored surgical counseling a clinical challenge. The aim of this study was to investigate the potential predictive value of the preoperative performance status for surgical outcome in patients with spinal metastases. METHODS: Performance status was determined using the Karnofsky Performance Scale (KPS), and surgical outcome was classified as "favorable" or "unfavorable" based on postoperative changes in neurological function and perioperative complications. The correlation between preoperative performance status and surgical outcome was assessed to determine a KPS-related performance threshold. RESULTS: A total of 463 patients were included. The mean age was 63 years (range: 22-87), and the mean preoperative KPS was 70 (range: 30-100). Analysis of clinical outcome in relation to the preoperative performance status revealed a KPS threshold between 40% and 50% with a relative risk of an unfavorable outcome of 65.7% in KPS ≤40% compared with the relative chance for a favorable outcome of 77.1% in KPS ≥50%. Accordingly, we found significantly higher rates of preserved or restored ambulatory function in KPS ≥50% (85.7%) than in KPS ≤40% (48.6%; P < .001) as opposed to a significantly higher risk of perioperative mortality in KPS ≤40% (11.4%) than in KPS ≥50% (2.1%, P = .012). CONCLUSION: Our results underline the predictive value of the KPS in metastatic spine patients for counseling and decision-making. The study suggests an overall clinical benefit of surgical treatment of spinal metastases in patients with a preoperative KPS score ≥50%, while a high risk of unfavorable outcome outweighing the potential clinical benefit from surgery is encountered in patients with a KPS score ≤40%.
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BACKGROUND: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. METHODS: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. RESULTS: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. CONCLUSION: Surgical treatment of spinal metastatic disease improves patients' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.
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Tumors of the spine are challenging in terms of diagnoses and interdisciplinary treatment. This study was conducted to evaluate and characterize a large multicenter cohort of surgically treated spine tumor patients.Data of the German Spine Society (DWG) were used to characterize a cohort of all surgically treated spine tumor cases that were registered between 2017 and 2021. Subgroup analysis was performed for tumor entity, tumor localization, height of most severely affected segments, surgical treatment, and demographic parameters.In total, there were 9686 cases, of which 6747 were "malignant", 1942 were "primary benign", 180 were "tumor-like lesions", and 488 were "other" spinal tumors. Subgroups showed differences in number of affected segments as well as localization. There were further significant differences in surgical complication rates (p = 0.003), age (p < 0.001), morbidity (p < 0.001), and duration of surgery (p = 0.004).This is a representative study on spinal tumors from a large spine registry and allows for the epidemiological characterization of surgically treated tumor subgroups and quality control of registry data.
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Introduction: The method of infant hip sonography according to Graf is used for general hip screening in Serbia, Austria, and Germany and is considered the gold standard. In other countries, such as the USA, however, it is not well accepted and is claimed to lead to high costs and overtreatment. The aim of this study was to investigate how many of the mentioned sources in a recent review article contained sonograms that met the quality criteria as taught in Graf's ultrasound courses. Methods: A systematic review published by Sakkers et al. was analyzed in terms of addressing the quality criteria of Graf's method. Studies that were suitable by title, abstract, manuscript, that contained an image of sonographic hip examination, and that were accessible were included into analysis. Results: Within the described review, there were 22 papers on the Graf method. Of these, 10 contained hip sonograms and were applicable for final analysis. The quality criteria according to Graf were not fulfilled within 5 of these 10 papers. Within these papers, there are examples of schematic sonograms that do not correspond with the quality criteria either. Conclusion: Skepticism regarding the Graf method may be based on user errors and insufficient application of the Graf quality assessment algorithm, which results in high intra- and inter-observer variations. Based on these findings, a working group was initiated to evaluate further work according to the same procedure (currently approximately 130 papers).
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Purpose: Sonographic hip examination according to Graf is widely accepted standard for diagnosing developmental dysplastic hips (DDH) but it is criticized for alleged intra- and interobserver variations. This review was conducted to evaluate whether objective quality criteria according to the Graf method are fulfilled within scientific literature. Methods: A systematic literature search on Pubmed was performed using the search string: [(DDH) OR (Hip dysplasia)] AND (Graf). Studies suitable by title, abstract, manuscript, containing an image of sonographic hip examination and online accessibility were included into analysis. Results: 131 studies were included into final analysis. Only 68 (51.9%) presented correct sonographic images according Graf's criteria. 98 (74.8%) studies plotted alpha-angles (angle between bony roof line and base line) but only 85 (64.8%) studies beta-angles (angle between cartilage roof line and base line). Studies were contributed from 25 countries. Conclusion: Assumingly, skepticism regarding the Graf method is based on user errors and insufficient application of the Graf quality assessment algorithm resulting in high intra- and interobserver variations. When performed correctly, the Graf method is of high diagnostic value.
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PURPOSE: Closed reduction and subsequent spica casting is the gold standard for treatment of unstable or dislocated developmental dysplastic hips (DDHs). There are few data on mid-term results after treatment of DDH, especially on closed reduction. METHODS: Thirty-one consecutive patients with unstable or dislocated hips (n = 36) that were treated by fluoroscopic, contrast agent-supported closed reduction and spica casting were included and evaluated clinically and radiologically 2 and 5 years after treatment. RESULTS: After 2 and 5 years, there were no significant differences between healthy and successfully treated hips that were detectable with respect to acetabular coverage (AC) angle, center-edge angle, and clinical stability of the hip. There was a significant difference at the 2-year follow-up between healthy hips and hips that needed to undergo secondary open reduction surgery (n = 4) with respect to the AC angle (p < 0.001). CONCLUSION: Closed reduction in DDHs results in acceptable clinical and radiological results in the mid-term follow-up. It remains unclear why some patients with subsequent sonographically matured hips show secondary deterioration and recurrence of dysplasia.
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There is an ongoing debate whether a surgical drainage is beneficial to prevent local accumulation of hematoma and to reduce the rate of wound infections, and neurological deficits. Data from the German Spine Society (DWG) registry were filtered for surgically treated spine tumor cases between 2017 and 2021. Cases were categorized into with (Group I) and without (Group II) placement of a surgical drainage. Subgroups were compared for demographic data, type of surgery, experience of the surgeon and postoperative surgical complications. 10,029 cases were included into final analysis (Group I: 3007; Group II: 7022). There was no significant difference between both groups regarding age or gender distribution. Average morbidity of patients was significantly elevated in Group I (p < 0.05) and the rates of invasive surgery were significantly increased in this group (p < 0.001). Overall complication rates were reported with 12.0% (Group I) and 8.5% (Group II). There were significantly more epidural hematoma (p < 0.001) and motor dysfunction (p = 0.049) as well as deep wound infections (p < 0.001) and implant failures (p = 0.02) in Group I. A surgical wound drainage cannot prevent epidural hematoma.
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Hematoma Epidural Craniano , Neoplasias , Infecção dos Ferimentos , Humanos , Sistema de Registros , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Drenagem/efeitos adversos , Neoplasias/complicaçõesRESUMO
BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5-120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.
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Artroplastia de Quadril , Prótese de Quadril , Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Pelve , Desenho de Prótese , Falha de Prótese , Reoperação/métodos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Anterior knee pain is a frequent symptom in young athletes. Symptomatic patellofemoral cartilage defects can occur after trauma, especially after patellar dislocation. Numerous cartilage repair methods are currently available. Due to co-pathologies, the outcome after patellofemoral cartilage repair is inferior to the treatment of cartilage defects of the tibiofemoral joint. Adequate addressing of coexisting pathologies is essential for treatment success. This review provides an overview of the different techniques of patellofemoral cartilage repair.