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AIM: Many rheumatoid arthritis (RA) patients prioritize pain improvement in treatment. As pain can result from various causes, including noninflammatory factors such as central sensitivity syndrome (CSS), we hypothesized that CSS might impact treatment satisfaction. In this cross-sectional study, we assessed the CSS effects on clinical disease activity and treatment satisfaction in RA patients. METHODS: In total, 220 consecutive RA patients receiving long-term follow-up were evaluated for clinical disease activity and treatment satisfaction. CSS was evaluated using the Central Sensitization Inventory (CSI). An overall score of ≥40 indicates the presence of CSS. We queried "How satisfied are you with your treatment?"; answers included (a) very satisfied, (b) satisfied, (c) not satisfied, or (d) very dissatisfied. For univariate analysis, we condensed these answers into "dissatisfied" or "satisfied." We also evaluated treatment satisfaction using the visual analog scale (VAS), with scores ranging from 0 mm (very dissatisfied) to 100 mm (very satisfied). RESULTS: Of the 220 patients, 17 (7.7%) were classified as having CSS. CSI score was significantly correlated with the clinical disease activity index (CDAI; r = .322, p < .01) and treatment satisfaction (r = -.336, p < .01). Regarding treatment satisfaction, univariate analysis revealed that patient global assessment (PtGA), pain VAS, Health Assessment Questionnaire-Disability Index (HAQ-DI), Disease Activity Score in 28 joints with C-reactive protein, CDAI, and CSI scores of patients who were satisfied with treatment differed significantly from those of dissatisfied patients. Multivariate analysis revealed that CSI, PtGA, and HAQ-DI scores were associated with treatment satisfaction. CONCLUSION: In RA patients, CSS may affect the disease activity index and reduce treatment satisfaction.
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Antirreumáticos , Artritis Reumatoide , Dimensión del Dolor , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Humanos , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/psicología , Artritis Reumatoide/tratamiento farmacológico , Femenino , Masculino , Persona de Mediana Edad , Estudios Transversales , Anciano , Resultado del Tratamiento , Antirreumáticos/uso terapéutico , Sensibilización del Sistema Nervioso Central , Adulto , Factores de Tiempo , Artralgia/fisiopatología , Artralgia/diagnóstico , Artralgia/psicología , Artralgia/terapiaRESUMEN
BACKGROUND CONTEXT: Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. METHODS: A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. RESULTS: Trans-iliac-trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. CONCLUSIONS: Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique.
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Autologous chondrocyte implantation (ACI) has been covered by insurance in Japan since April 2013, expanding the range of treatments for extensive knee cartilage damage. Initially, the periosteum was used for the fixation of cultured cartilage, but since February 2019, the introduction of collagen membranes has shortened surgery time and simplified the procedure. We report a case where we used the knotless suture bridge technique for a more straightforward and secure fixation with a collagen membrane. The patient was a 61-year-old male who experienced right knee pain a year earlier when stepping downstairs. Conservative treatment at a local hospital was ineffective, and he was referred to our department. At the initial examination, the right knee had an extension of -5° and a flexion of 130°. A simple X-ray of the right knee showed osteosclerosis with a translucent bone image at the medial femoral condyle. Weight-bearing full-length X-ray of the lower limb showed a femorotibial angle (FTA) of 186°, a hip-knee-ankle (HKA) angle of 12.5° varus, a percentage of mechanical axis (%MA) of 15%, and a medial proximal tibial angle (MPTA) of 78°, indicating a significant varus deformity. CT and MRI revealed a cartilage defect of 36 mm in length and 16 mm in width and a bone defect with a maximum depth of 15 mm at the medial femoral condyle. The patient underwent surgery for a traumatic cartilage defect of the medial femoral condyle. For the bone defect, autologous bone grafting was performed, and for the cartilage defect, ACI was done. The ACI involved fixation with a collagen membrane using 1.3 mm suture tape and BC PushLock anchor (Arthrex, Naples, Florida, United States) in a knotless suture bridge technique. Additionally, hybrid closed-wedge high tibial osteotomy (HCWHTO) was performed for alignment correction. At eight months post surgery, MRI proton density sagittal images confirmed the joint surface by the cartilage layer, and the Modified Outerbridge Cartilage Repair Assessment (MOCART) score was 80. At 12 months post surgery, the Japanese version of the Knee Injury and Osteoarthritis Outcome Score (J-KOOS) improved from 46.43 to 82.14 for symptoms, 58.33 to 83.33 for pain, 95.59 to 100 for activities of daily living (ADL), 45 to 75 for sports, and 68.75 to 87.50 for quality of life (QOL). X-rays showed an FTA of 173°, an HKA of 0°, and a %MA of 58%, indicating a favorable course. The knotless suture bridge technique for collagen membrane fixation during ACI is considered a convenient and time-saving method.
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In unicompartmental knee arthroplasty (UKA), the tibial component has a small coronal plane width, the tibia and tibial component rotations are mismatched, and the large tibial component posterior tilt may make accurate measurements of component positions difficult in radiography. The study aimed to assess the intra- and interobserver reliabilities of radiographic (2D) and 3D computed tomography (3D-CT) measurements and to determine the minimum detectable change (95% confidence level, MDC95) in the tibial component position measurements in UKA. The study included 23 females and 7 males. Two surgeons measured the tibial component position. Intraclass and interclass correlation coefficients (ICC) were calculated to obtain reliability, and Bland-Altman analysis was performed to assess systematic errors. The MDC95 was calculated according to MDC95 = standard error of measurement × 1.96 × â2. In the 2D and 3D- CT measurements, intraobserver reliability for coronal and sagittal positions of the tibial component were sufficiently reliable, where ICCs were >0.8. In the coronal plane, the ICCs for interobserver reliability were lower in 2D (ICC, 0.5-0.7) than in 3D-CT (ICC > 0.9). Bland-Altman plots showed systematic bias in sagittal alignment in the 2D assessment. In the 3D assessment of intra- and interobserver reliability, the MDC95 of the coronal, sagittal, and axial planes was <2°. In the 2D intra- and interobserver reliability, the MDC95 of the coronal and sagittal planes was >2°. The 2D measurement had a risk of misidentifying the tibial component position in UKA.
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Artroplastia de Reemplazo de Rodilla , Masculino , Femenino , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Tibia/diagnóstico por imagen , Tibia/cirugía , Reproducibilidad de los Resultados , Radiografía , Imagenología Tridimensional/métodos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugíaRESUMEN
Background: Sagittal stability in total knee arthroplasty is achieved through complex processes enabled by prosthetic design and intraoperative soft tissue balancing. This study investigated the effects of preserving medial soft tissue on sagittal stability in bicruciate stabilized total knee arthroplasty (BCS TKA). Method: This retrospective study included 110 patients who underwent primary BCS TKA. The patients were divided into two groups: 44 TKAs were performed releasing medial soft tissue (CON group), and 66 TKAs were performed preserving medial soft tissue (MP group). We assessed joint laxity using tensor device and anteroposterior translation immediately after surgery using the arthrometer at 30° knee flexion. Propensity score matching (PSM) was performed according to preoperative demographic and intraoperative medial joint laxity, and further comparisons between the two groups were performed. Result: After PSM analysis, medial joint laxity in the mid-flexion range tended to be smaller in the MP group than in the CONT group, with a significant difference at 60 degrees (CON group: - 0.2 ± 0.9 mm, MP group: 0.8 ± 1.3 mm, P < 0.05). Anteroposterior translation was significantly different between the two cohorts (CON group: 11.6 ± 2.5 mm, MP group: 8.0 ± 3.1 mm, P < 0.001). Conclusion: This study demonstrated the effects of preserving medial soft tissue on postoperative sagittal stability in BCS TKA. We concluded that this surgical procedure enhances postoperative sagittal stability in the mid-flexion range in BCS TKA.
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A fully hydroxyapatite (HA)-coated stem such as Corail stem, that compacts the cancellous bone around the stem in total hip arthroplasty (THA), is reported to have good long-term results for more than 20 years. Although various fully HA-coated stems have being used recently, it is unclear whether there are differences in the postoperative outcomes. In this study, 224 patients (234 hips) with THA using either the Corail collarless stem or the Hydra stem were enrolled. And then we performed a retrospective comparison of the data at 2 years postoperatively using propensity score matching analysis. The postoperative modified Harris hip scores in 84 hips each group were 93.6 ± 8.2 points in the Corail group and 92.8 ± 10.1 points in the Hydra group, and there was no significant difference between the two groups. However, there was significantly less stem subsidence and rate of 3rd degree or greater stress shielding in the Corail group. Although these two stems were similar collarless fully HA-coated stems and clinical outcomes were favorable results in both groups at 2 years postoperatively, radiographic evaluations showed statistically significant differences between the two groups.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Durapatita , Estudios Retrospectivos , Estudios de Seguimiento , Puntaje de PropensiónRESUMEN
Few studies have reported on the use of knotless suture anchors to treat patellar tendon rupture from tibial tuberosity after total knee arthroplasty (TKA). We report a case of patellar tendon rupture in an 82-year-old female. She fell 8 weeks after bilateral TKA and presented with a patellar tendon rupture. A knotless suture anchor and a fully threaded Twist-In knotless anchor with flat-braided suture were used to repairing the patellar tendon. Complications related to the extension mechanism after TKA can lead to disastrous consequences. This surgical procedure is a safe and good treatment option to repair patellar tendon rupture after TKA.
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Promoting bone healing after a fracture has been a frequent subject of research. Recently, sclerostin antibody (Scl-Ab) has been introduced as a new anabolic agent for the treatment of osteoporosis. Scl-Ab activates the canonical Wnt (cWnt)-ß-catenin pathway, leading to an increase in bone formation and decrease in bone resorption. Because of its rich osteogenic effects, preclinically, Scl-Ab has shown positive effects on bone healing in rodent models; researchers have reported an increase in bone mass, mechanical strength, histological bone formation, total mineralized callus volume, bone mineral density, neovascularization, proliferating cell nuclear antigen score, and bone morphogenic protein expression at the fracture site after Scl-Ab administration. In addition, in a rat critical-size femoral-defect model, the Scl-Ab-treated group demonstrated a higher bone healing rate. On the other hand, two clinical reports have researched Scl-Ab in bone healing and failed to show positive effects in the femur and tibia. This review discusses why Scl-Ab appears to be effective in animal models of fracture healing and not in clinical cases.
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Periprosthetic joint infection (PJI) is suspected when local findings such as pain, swelling, hyperthermia, and sinus tract are present. However, the frequency of these findings and the difference between hip and knee are unclear. This study compared the positive rates of local findings in periprosthetic hip infection (PHI) with periprosthetic knee infection (PKI), and aimed to identify potential risk factors associated with the frequency. One hundred one PJI (46 hips and 55 knees) fulfilled the 2018 Musculoskeletal infection society criteria were analysed retrospectively to assess the positive rates of each local finding. Patients were categorized into two groups based on the presence or absence of each local finding, and the influence of two potential risk factors [body mass index (BMI) and C-reactive protein (CRP)] was investigated. Causative bacterial species were divided into high and low-virulent groups, and then culture negative cases were included in low-virulent group. PHI had significantly lower rates of pain, swelling and hyperthermia compared to PKI. Overall, up to one-third of PHI had pain as only symptom. High BMI and low-virulent bacteria were associated with lower frequency of swelling and hyperthermia in PHI. CRP had no impact on positive rates of local findings. PHI was oligosymptomatic in a significant percentage of cases. This is particularly important in obese patients and infection by low-virulent bacteria.
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Artritis Infecciosa/etiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Infecciones Bacterianas/etiología , Infecciones Relacionadas con Prótesis/etiología , Anciano , Anciano de 80 o más Años , Bacterias/patogenicidad , Biomarcadores , Susceptibilidad a Enfermedades , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , VirulenciaRESUMEN
In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (N = 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (N = 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Fémur/cirugía , Humanos , Rótula , Rango del Movimiento Articular , Estudios RetrospectivosRESUMEN
BACKGROUND: In rheumatoid arthritis, forefoot disease activity can lead to joint damage, pain, and disability during weight-bearing activities; therefore, the evaluation and control of forefoot disease activity is important. We aimed to investigate an association between the prevalence of abnormalities in the forefoot based on ultrasonography (US) and the clinical and US findings related to arthritis and identify factors related to the presence of synovitis in the forefoot of RA patients. METHODS: In total, 810 metatarsophalangeal joints of 81 rheumatoid arthritis patients were examined using US. Patients were assigned to either a forefoot synovitis group (n = 22), with foot synovitis detected using US, or a non-forefoot synovitis group (n = 59). We assessed associations between clinical parameters and US finding of the hand and US finding of the metatarsophalangeal joints. RESULTS: The following were significantly higher in forefoot synovitis group than in non-forefoot synovitis group: swollen joint count [P < 0.001]; Disease Activity Score 28 based on C-reactive protein [P < 0.05]; clinical disease activity index [P < 0.001]; and total Power Doppler score of the hand [P < 0.001]. Receiver-operating characteristic analysis for total Power Doppler scores of the hand to suggest the presence of synovitis in the metatarsophalangeal joints showed that a total Power Doppler score of the hand of ≥5 was associated with synovitis in the metatarsophalangeal joints, with a sensitivity of 68% and a specificity of 85% (odds ratio = 11.9). CONCLUSION: Total Power Doppler scores of the hand had a good valuable score for suggesting the presence of synovitis in metatarsophalangeal joints of rheumatoid arthritis patients.
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Artritis Reumatoide , Sinovitis , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Mano , Humanos , Índice de Severidad de la Enfermedad , Sinovitis/diagnóstico por imagen , Sinovitis/etiología , Ultrasonografía , Ultrasonografía DopplerRESUMEN
OBJECTIVES: The details of relationship between bacterial culture results of preoperative and intraoperative specimens in same patients with native joint septic arthritis (NJSA) and periprosthetic joint infection (PJI) are unknown. This study aims to reveal the difference of culture results of preoperative synovial fluid and intraoperative specimens and evaluate the risk factors for detecting different species intraoperatively from preoperative synovial fluid. METHODS: This study included 55 joints diagnosed with 16 NJSA and 39 PJI. Bacterial culture positive rates and identified bacterial species were compared between preoperative synovial fluid and intraoperative tissue/synovial fluid. We also examined the presence or absence of sinus tracts and antimicrobial agents as risk factors in patients with different bacterial species in intraoperative specimens from preoperative synovial fluid. RESULTS: The culture positive rates were not significantly different between preoperative synovial fluid and intraoperative specimens. Different bacterium were detected in 10.9% joints by intraoperative tissue and 14.6% joints by intraoperative synovial fluid. The positive rate of sinus tract was significantly higher in patients with different bacterial species (62.5%) than without different bacterial species (12.8%, p < 0.01). Conversely, antimicrobial agent was not significantly difference. CONCLUSION: This study demonstrated that different bacterium from preoperative culture results were detected in 10-15% joints by intraoperative specimens in NJSA and PJI. The sinus tract was a risk factor for identifying different bacterial species in the intraoperative specimens. Therefore, in cases of sinus tract, it is necessary to examine multiple specimens of both intraoperative tissue and synovial fluid for increasing the detection rate.
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Artritis Infecciosa , Infecciones Relacionadas con Prótesis , Artritis Infecciosa/diagnóstico , Bacterias , Humanos , Sensibilidad y Especificidad , Líquido SinovialRESUMEN
OBJECTIVE: To investigate whether presepsin can be used as a novel biomarker to differentiate between native joint septic arthritis (NJSA) and crystal arthritis (CA). METHODS: This study included 75 patients diagnosed with either NJSA (n = 21) or CA (n = 54). Presepsin in synovial fluid and blood, C-reactive protein, and procalcitonin were measured and compared between the NJSA and CA groups. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups. RESULTS: Synovial fluid and blood presepsin were significantly higher in the NJSA group than in the CA group (p < 0.0001 and p < 0.01, respectively). The area under the ROC curve for synovial fluid presepsin in the NJSA group compared with the CA group was 0.93 (sensitivity 85.7%, specificity 85.2%, positive predictive value 69.2%, negative predictive value 93.9%, positive likelihood ratio 5.79, negative likelihood ratio 0.17). Among the tests, synovial fluid presepsin was the most accurate. CONCLUSIONS: Measurement of synovial fluid presepsin is reliable for the early diagnosis of NJSA, and synovial fluid presepsin could be used as a novel biomarker for differentiating between NJSA and CA.
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Artritis Infecciosa/diagnóstico , Biomarcadores/análisis , Artropatías por Depósito de Cristales/diagnóstico , Receptores de Lipopolisacáridos/análisis , Fragmentos de Péptidos/análisis , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/metabolismo , Artritis Infecciosa/terapia , Artrocentesis , Proteína C-Reactiva/análisis , Estudios Transversales , Artropatías por Depósito de Cristales/metabolismo , Artropatías por Depósito de Cristales/terapia , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Masculino , Polipéptido alfa Relacionado con Calcitonina/análisis , Curva ROC , Sensibilidad y Especificidad , Líquido Sinovial/metabolismoRESUMEN
PURPOSE: This study investigated the effect of mediolateral stability on sagittal stability in bi-cruciate stabilized total knee arthroplasty. METHOD: This study included 59 patients. We intraoperatively assessed the component gap with a joint distraction force of 60 N for each compartment. Immediately after surgery, sagittal stability was assessed using an arthrometer. RESULT: The intraoperative medial joint laxity at 30° of flexion was significantly correlated with postoperative anteroposterior translation (r = 0.276, p < 0.05). CONCLUSION: This study demonstrated the effect of intraoperative mediolateral stability effect on postoperative sagittal stability. Improving medial stability may enhance postoperative sagittal stability.
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Therapeutic outcomes for septic arthritis vary greatly depending on the span of time between disease-onset and surgery. The most important factor is making an early and definitive diagnosis; however, some cases may be difficult to diagnose. We investigated presepsin, a biomarker of sepsis, to determine whether or not presepsin in synovial fluid would be useful for the diagnosis of septic arthritis. We selected 18 patients with septic arthritis including periprosthetic joint infections (SA group) and 28 patients with osteoarthritis (OA group). We measured the concentrations of synovial fluid presepsin, blood presepsin and procalcitonin (PCT) in the two groups. We compared the sensitivities and specificities of synovial fluid presepsin, blood presepsin and PCT. Synovial fluid and blood presepsin and blood PCT were all significantly higher in the SA group. Synovial fluid presepsin exhibited both 100% sensitivity and 100% specificity in the SA group, which were higher rates than those for blood presepsin and PCT. We found that synovial fluid presepsin is markedly elevated in case of septic arthritis, and therefore, it has potential as a new biomarker of septic arthritis.
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Artritis Infecciosa/diagnóstico , Receptores de Lipopolisacáridos/análisis , Fragmentos de Péptidos/análisis , Líquido Sinovial/química , Anciano , Anciano de 80 o más Años , Biomarcadores/análisis , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Clinical outcomes of total hip arthroplasty for rheumatoid arthritis are reportedly worse than those of total hip arthroplasty for osteoarthritis of the hip. The authors examined pre- and postoperative factors associated with the modified Harris hip score (mHHS). Fifty-one joints of 48 rheumatoid arthritis patients who underwent total hip arthroplasty were studied retrospectively. The authors examined the correlation between preoperative rheumatoid arthritis disease activity (Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein) and mHHS at 1 year after total hip arthroplasty. Furthermore, pre- and postoperative mHHS values were compared between patients with other affected joints and patients with no affected joints in the lower limbs. The mean mHHS improved to 73.5 points postoperatively from 36.4 points preoperatively. Preoperative Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein values were negatively correlated with pre- and postoperative mHHS values. Preoperative mHHS was not significantly different between the affected and not affected groups; however, postoperative mHHS was significantly lower in the affected group than in the not affected group. Total hip arthroplasty showed good clinical results for rheumatoid arthritis at short-term follow-up. However, pre- and postoperative mHHS values were influenced by preoperative rheumatoid arthritis disease activity. Moreover, the presence of additional affected joints in the lower limbs preoperatively resulted in a lower postoperative mHHS. Unlike patients with osteoarthritis, patients with rheumatoid arthritis often have multiple affected joints, which may contribute to a lower mHHS. Comprehensive treatment, including surgery for the other affected joints in the lower limbs, may improve a patient's postoperative mHHS. [Orthopedics. 2018; 41(6):e772-e776.].
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Artritis Reumatoide/fisiopatología , Artritis Reumatoide/cirugía , Artroplastia de Reemplazo de Cadera , Índice de Severidad de la Enfermedad , Anciano , Artritis Reumatoide/sangre , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Hip dislocation associated with Down syndrome is relatively rare. Hip dislocation can progress to severe subluxation or habitual dislocation if the initial therapy is improperly performed. However, definitive treatment guidelines for conservative and surgical therapy for hip dislocation in patients with Down syndrome have not been established. This article describes a case of a 12-year-old girl with Down syndrome with nontraumatic habitual hip dislocation. Her hip joint was associated with acetabular dysplasia and hypoplasia of the posterior acetabular wall. Although conservative therapy was initially performed, no effects were observed. Rotational acetabular osteotomy and capsular plication were performed to reconstruct the posterior acetabular wall. No postoperative redislocation occurred, and the treatment effects were favorably sustained for 2 years. In Down syndrome, few cases of developmental dysplasia and hypoplasia of the posterior acetabular wall have been reported. In previous reports, these morphological abnormalities were rarely taken into consideration when determining the treatment strategy, and to our knowledge, no other reports demonstrate therapy involving rotational acetabular osteotomy for hip dislocation complicated with Down syndrome. Whether the acetabulum had posterior wall deficiency was thought to be important for conservative and surgical therapies in hip dislocation in patients with Down syndrome. Rotational acetabular osteotomy could be an effective surgical procedure for reconstruction of the acetabulum by posterolateral rotation of the osteotomized acetabulum.
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Acetábulo/cirugía , Síndrome de Down/cirugía , Luxación de la Cadera/cirugía , Inestabilidad de la Articulación/cirugía , Acetábulo/diagnóstico por imagen , Niño , Síndrome de Down/diagnóstico por imagen , Femenino , Luxación de la Cadera/diagnóstico por imagen , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Radiografía , Rotación , Resultado del TratamientoRESUMEN
INTRODUCTION: Calcific myonecrosis is a rare condition characterized by a calcified lesion. Because this lesion sometimes presents as a huge mass with unique radiographic characteristics, it can be confused with soft tissue sarcoma. The appropriate treatment is still controversial. We report here three cases diagnosed as calcific myonecrosis of the lower leg and discuss its clinical presentation, diagnosis and options for treatment. PATIENTS AND METHODS: Three patients presented as expanding masses in the anterior or lateral compartment muscle and occurred more than 10 years after an initial injury. Plain radiographs showed a large soft tissue mass with extensive amorphous calcifications. Computed tomograms revealed a low-density tumor with scattered calcifications. Magnetic resonance imaging showed a bright, high-signal area on T2-weighted imaging consistent with fluid. Two patients underwent excisions for histopathological evaluation and one was treated conservatively because of the absence of disability. RESULTS: Two operative patients had no complication and the returned to work without evidence of deterioration of the disease. In a patient treated conservatively, the mass was not enlarged and was still painless at 2-year follow-up. CONCLUSION: The key points for diagnosis were (1) amorphous liner calcification, (2) anterior or lateral compartment, (3) previous injury (several decades) of the tibia or femur, and (4) compartment syndrome. Although calcific myonecrosis is not commonly encountered, it must be considered in the differential diagnosis of an expanding intramuscular mass. In asymptomatic masses where the diagnosis is recognized, observation may be possible and unnecessary aggressive surgical intervention should be avoided.