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1.
Acta Orthop Belg ; 86(2): 249-252, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33418615

RESUMO

Total Hip Arthroplasty (THA) joint infection is an uncommon (0,3-1,7%) (20) but devastating complication after THA. While mostly caused by Gram-positive bacteria, with staphylococci and streptococci accounting for up to 76% of cases (21), orthopaedic surgeons are sometimes faced with atypical germs such as fungi or mycobacteria. We present a case of THA joint infection caused by Mycobacterium tuberculosis (MT) in a patient without a previous history of MT infection. A literature review was performed, and the treatment is discussed.


Assuntos
Antituberculosos/administração & dosagem , Artroplastia de Quadril , Articulação do Quadril , Mycobacterium tuberculosis/isolamento & purificação , Infecções Relacionadas à Prótese , Idoso de 80 Anos ou mais , Artrocentese/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Doença Crônica , Diagnóstico Diferencial , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/microbiologia , Prótese de Quadril/efeitos adversos , Prótese de Quadril/microbiologia , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/fisiopatologia , Recuperação de Função Fisiológica , Reoperação/métodos , Líquido Sinovial/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Knee Surg Sports Traumatol Arthrosc ; 26(4): 1080-1085, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28638970

RESUMO

PURPOSE: The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL-injured patients with or without an associated ramp lesion. METHODS: Two hundred and twenty-four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi-square tests were used to compare the population of ACL-injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05. RESULTS: Fifty-three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non-contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49-5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15-66.12] times more likely if the ACL tear was complete. CONCLUSION: Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear. LEVEL OF EVIDENCE: III.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Artroscopia , Lesões do Menisco Tibial/complicações , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Ruptura , Lesões do Menisco Tibial/cirurgia , Adulto Jovem
3.
Am J Sports Med ; 46(1): 72-78, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28952782

RESUMO

BACKGROUND: The glenoid track concept describes the dynamic interaction of bipolar bone loss in anterior glenohumeral instability. Initial studies have successfully demonstrated this concept's application in clinical populations. In clinical practice, the Latarjet procedure is commonly the preferred treatment in addressing "off-track" Hill-Sachs lesions. The effectiveness of this procedure in restoring such lesions to an "on-track" state, however, has not yet been evaluated or described in the literature. HYPOTHESIS: The Latarjet procedure would transform "off-track" Hill-Sachs lesions to "on-track" lesions. Lesions would remain "on-track" during follow-up, despite glenoid remodeling. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients with "off-track" Hill-Sachs lesions treated with the arthroscopic Latarjet procedure between March 2013 and May 2014 were included. Glenoid track and coracoid graft contact surface area measurements using 3-dimensional computed tomography (3D-CT) were performed preoperatively and at 6-week, 6-month, and at least 12-month (final) follow-up. The mean final follow-up was 23 months. The glenoid diameter, as a percentage of the native glenoid, was also calculated from this imaging. RESULTS: Twenty-six patients met the inclusion criteria. 3D-CT scans were available for all patients preoperatively and postoperatively, with 21 patients (81%) undergoing 6-month follow-up CT and 19 patients (73%) undergoing final follow-up CT. Hill-Sachs lesions remained "on-track" at all follow-up time points. The mean glenoid diameter changed significantly from 84.6% preoperatively to 122.8% at 6 weeks ( P < .001) and from 120.5% at 6 months to 113.9% at final follow-up ( P = .005). This was also reflected in significant remodeling seen in the coracoid graft articular contact area (6 weeks to 6 months, P = .024; 6 months to final follow-up, P = .002). This persisting glenoid arc enlargement at final follow-up avoided "off-track" Hill-Sachs lesions in 6 of 19 patients (32%), which would otherwise have occurred had the coracoid graft remodeled to native glenoid dimensions. CONCLUSION: The Latarjet procedure provides an effective treatment for "off-track" engaging Hill-Sachs lesions, despite an evident glenoid remodeling process. At a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained, avoiding a recurrent "off-track" lesion in 32% of patients, which would otherwise have occurred with complete remodeling.


Assuntos
Artroplastia/métodos , Lesões de Bankart/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Escápula/cirurgia , Luxação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
4.
JBJS Essent Surg Tech ; 7(2): e13, 2017 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-30233948

RESUMO

The subscapularis is the largest and strongest muscle of the rotator cuff, and it plays an essential role in global shoulder function. Beyond its primary function as an internal rotator, the subscapularis also acts to pull the humeral head posteriorly on the glenoid and is an important dynamic and static anterior stabilizer of the glenohumeral joint. In comparison with tears of the tendons of the rest of the rotator cuff, isolated tears of the subscapularis have a tendency for both early retraction and fatty infiltration. Consequently, full-thickness tears of the subscapularis tendon generally require surgical management. Arthroscopic suture-anchor repair allows anatomic reconstruction of the anterior aspect of the rotator cuff, with all of the benefits of arthroscopic surgery. The principal steps of this procedure include (1) verifying the subscapularis tear and identifying any concomitant lesions during diagnostic arthroscopy, (2) exposing the subscapularis tendon, (3) releasing tendon adhesions and so enabling anatomic reduction, (4) placing suture anchors at the anatomic subscapularis footprint on the lesser tuberosity and anatomically repairing the subscapularis tendon to its anatomic insertion, and (5) performing biceps tenodesis or tenotomy, if indicated. Postoperatively, patients with an isolated subscapularis tear are managed with immobilization in a sling for 6 weeks, while those with combined anterosuperior rotator cuff tears are managed with an abduction pillow. Arthroscopic subscapularis reconstruction provides a good structural repair, substantially restores shoulder mobility and strength, reduces pain, and results in high levels of patient satisfaction and return of shoulder function as measured by functional outcome scores.

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