RESUMEN
Revision anterior cruciate ligament reconstruction remains a challenge, especially optimising outcome for patients with a compromised knee where previous autogenous tissue has been used for reconstruction. Allograft tissue has become a recognized choice of graft for revision surgery but questions remain over the risks and benefits of such an option. Allograft tendons are a safe and effective option for revision ACL reconstruction with no higher risk of infection and equivalent failure rates compared to autografts provided that the tissue is not irradiated, or any irradiation is minimal. Best scenarios for use of allografts include revision surgery where further use of autografts could lead to high donor site morbidity, complex instability situations where additional structures may need reconstruction, and in those with clinical and radiologic signs of autologous tendon degeneration. A surgeon needs to be able to select the best option for the challenging knee facing revision ACL reconstruction, and in the light of current data, allograft tissue can be considered a suitable option to this purpose.Level of evidence IV.
Asunto(s)
Aloinjertos , Reconstrucción del Ligamento Cruzado Anterior , Reoperación , Tendones/trasplante , Humanos , Complicaciones Posoperatorias , Cuidados Preoperatorios , Reoperación/métodos , Volver al Deporte , Manejo de Especímenes , Esterilización/métodosRESUMEN
BACKGROUND: Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known. METHODS: We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009. RESULTS: Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04). CONCLUSIONS: The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.
Asunto(s)
Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Rifampin/administración & dosificación , Infecciones Estreptocócicas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Artritis/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Prótesis de Cadera/efectos adversos , Prótesis de Cadera/microbiología , Humanos , Articulación de la Rodilla/microbiología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Prótesis de la Rodilla/microbiología , Levofloxacino/administración & dosificación , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Estudios Retrospectivos , Infecciones Estreptocócicas/etiología , Resultado del TratamientoRESUMEN
Surgical site infection after emergency hand surgery can cause considerable morbidity and, in the most severe forms, even toxic shock syndrome. Postoperative antibiotic prophylaxis aims to reduce the number of surgical site infections. However, excessive use of antibiotics induces side-effects for patients and antibiotic resistance for society. Contrary to other orthopedic sites, there is no consensus on postoperative antibiotic prophylaxis in open hand trauma beyond analogic reasoning with no proven scientific validity. Our hypothesis was that absence of postoperative antibiotic prophylaxis after open hand trauma surgery does not affect the rate of surgical site infections. A prospective cohort study included 405 patients, operated on in the emergency hand trauma unit without intra- or post-operative antibiotic prophylaxis. Patients were followed up in consultation at 7, 14 and 30 days. Surgical site infection was defined by need for surgery for detersion and flattening, followed by curative antibiotic therapy. The surgical site infection rate was 2.22%. Four patients were lost to follow-up and counted as surgical site infection as originally planned in the worst-case analysis. There were five surgical revisions followed by antibiotic therapy. These results do not differ from those reported in the literature, and thus confirm our hypothesis that postoperative antibiotic prophylaxis is not indicated in open hand trauma management.
Asunto(s)
Profilaxis Antibiótica , Mano , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Mano/cirugía , Humanos , Estudios Prospectivos , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Pyogenic flexor tenosynovitis is a frequent and serious condition. However, there is no consensus on the use of antibiotics. The objective of our study was to describe the treatment of this condition and to identify the surgical and medical management parameters to propose an effective and consensual postoperative antibiotic therapy protocol. We retrospectively reviewed pyogenic flexor tenosynovitis of the thumb or fingers treated between 01/01/2013 and 01/01/2018 at a teaching hospital. Inclusion criteria were confirmation of the clinical diagnosis intraoperatively and a minimum post-antibiotic follow-up of 6 months. Comorbidities, type of surgery, antibiotic therapy parameters, and treatment outcome were assessed. One hundred and thirteen patients were included. Fifty-four percent had comorbidities. The most frequent germ was staphylococcus, all patients received postoperative antibiotic therapy. Intravenous or intravenous followed by oral administration did not provide any benefit compared to an exclusively oral treatment (p = 0.46). The duration of postoperative antibiotic therapy (less than 7 days, between 7 and 14 days or more than 14 days) did not lead to any difference in healing rate (p = 0.67). However, treating for less than 7 days versus 7-14 days seemed to be associated with a higher risk of failure, although not statistically significant. Oral postoperative antibiotic therapy with amoxicillin + clavulanic acid for 7-14 days appears to be effective, allowing for outpatient management.
Asunto(s)
Tenosinovitis , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Dedos/cirugía , Humanos , Estudios Retrospectivos , Tenosinovitis/tratamiento farmacológicoRESUMEN
A 31-year-old female patient presented with swelling on the anteromedial aspect of her right elbow with a sensory deficit in the median nerve territory. Biopsies led to the diagnosis of intraneural perineurioma (INP). Surgical excision was performed and followed by an intercalary graft. INP is a rare benign tumor of the peripheral nerves characterized by a multiplication of perineural cells invading the endoneurium. This lesion is often unknown, under-diagnosed, and its treatment is poorly defined. Few cases have been described in the literature; the majority involve the median nerve at the wrist and no references have been found about its localization to the median nerve at the elbow.
Asunto(s)
Articulación del Codo , Neoplasias de la Vaina del Nervio , Neoplasias del Sistema Nervioso Periférico , Adulto , Codo/cirugía , Femenino , Humanos , Nervio Mediano/cirugía , Neoplasias de la Vaina del Nervio/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugíaRESUMEN
Partial trapeziectomy for basal joint arthritis is an alternative to total trapeziectomy that preserves the height of the thumb column. Using arthroscopy reduces the incidence of periarticular lesions and the risks of complications. The purpose of this prospective single-center study was to evaluate the results of arthroscopic partial trapeziectomy combined with suspension and interposition ligament reconstruction using half of the abductor pollicis longus tendon. Twenty patients (18 women, 2 men) with a mean age of 55 years (43-65 years) were operated using this technique between November 2013 to February 2015. Patients were evaluated clinically and radiologically at 1 month, 3 months, 6 months and 12 months after surgery. The 20 patients were reviewed after 12 months. The subjective QuickDASH score improved from the 3rd post-operative month (P = 0.0029) from 50.6 preoperatively to 30.3 after 3 months, 17.6 after 6 months and 9.6 after 12 months. Pain was reduced in the 1st month post-operative (P < 0.0001). The Kapandji Score and pinch strength improved from the 3rd month (P = 0.034). Return to work was possible for 19% of employed patients after 1 month, 44% after 3 months and 87.5% after 6 and 12 months. Eighty-eight percent of the patients were satisfied or very satisfied after 3 months and 95% after 6 and 12 months. Pain levels, range of motion and QuickDASH Score are similar to those of open partial trapeziectomy described in the literature. However, recovery seems to be faster with this arthroscopic technique. Arthroscopic treatment of basal joint arthritis, which limits capsule and ligament lesions, leads to good short- and medium-term results in terms of pain relief and thumb motion while preserving strength. LEVEL OF EVIDENCE: 4 (Prospective, non-randomized).
Asunto(s)
Artritis/cirugía , Artroscopía , Articulaciones Carpometacarpianas/cirugía , Ligamentos Articulares/cirugía , Transferencia Tendinosa , Hueso Trapecio/cirugía , Adulto , Anciano , Artritis/fisiopatología , Articulaciones Carpometacarpianas/fisiopatología , Evaluación de la Discapacidad , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Reinserción al Trabajo , Pulgar/fisiopatología , Pulgar/cirugía , Escala Visual AnalógicaRESUMEN
BACKGROUND: Aseptic loosening, the most common indication for revision surgery in total hip arthroplasty, can result from osteolysis caused by polyethylene (PE) wear particles. PE wear is increased by age-related oxidation of PE and free radicals emerging during irradiation cross-linking. Diffusion of vitamin E into PE stabilizes free radicals to maintain the biomechanical properties of PE. The purpose of this study was to determine whether vitamin E-infused highly cross-linked PE cups could reduce wear rates. METHODS: We performed a prospective randomized controlled trial, in which 62 patients were allocated to 2 groups: a study group that received a vitamin E-infused highly cross-linked PE (HXLPE/VitE) cup and a control group that received an ultra-high molecular weight PE (UHMWPE) cup. Using radiostereometric analysis, we measured the penetration of the femoral head into the cup 7 days after surgery (baseline) and then again at 6 months and at 1, 2, and 3 years later. RESULTS: Baseline variables did not differ significantly between the groups. At 1, 2, and 3 years after surgery, the HXLPE/VitE cup showed significantly less cumulative penetration (creep and wear) than the UHMWPE cup (p = 0.004, p < 0.0001, and p < 0.0001, respectively). The cumulative penetration after 3 years was 0.200 mm for the HXLPE/VitE cup versus 0.317 mm for the UHMWPE cup (p < 0.0001). From 1 to 3 years after surgery, after creep had stabilized and further penetration was mainly due to wear, the mean penetration increased only 0.04 mm in the HXLPE/VitE cup and 0.116 mm in the UHMWPE cup. CONCLUSIONS: Our results confirm that wear rates over the first 3 years following surgery were lower in HXLPE/VitE cups than in UHMWPE cups. This suggests that HXLPE/VitE cups may prevent osteolysis, implant loosening, and eventually revision surgery. Long-term follow-up data continue to be collected to confirm these findings. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Polietileno/efectos adversos , Polietileno/química , Diseño de Prótesis , Falla de Prótesis , Vitamina E/uso terapéutico , Adulto , Anciano , Fenómenos Biomecánicos , Reactivos de Enlaces Cruzados/química , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peso Molecular , Osteólisis , Estudios Prospectivos , Análisis RadioestereométricoRESUMEN
PURPOSE OF THE STUDY: The knee has little capacity for spontaneous regeneration of deep cartilage defects. In 1999, the French Society of Arthroscopy initiated a multicentric clinical trial on autologous chondrocyte transplantation using the technique described by Brittberg and Peterson. The protocol of this prospective study was validated by the ethics committee and all patients provided the informed consent for participation. MATERIAL AND METHODS: Patients underwent surgery in seven hospitals: 28 patients (7 female, 21 male, mean age 28 years, age range 18-45 years). The underlying condition was: osteochondritis (n=14), isolated posttraumatic chondropathy (n=8), chondropathy plus ACL tear (n=6). All patients presented deep condylar cartilage defects (ICRS grades 3 and 4). Mean surface area involved after debridement was 490 mm2 (range 150-1050 mm2). Patients were reviewed two years at least after transplantation for functional assessment and an MRI performed 2 to 3 years after transplantation. Control arthroscopy was also performed in 13 patients with biopsy for histology and immunohistochemistry for 10. RESULTS: Twenty-six patients were reviewed with more than two years follow-up (mean 2 years 9 months). There were no general complications; three patients presented a partial avulsion of the autograft treated arthroscopically and one arthrolysis was performed at six months. Function was improved in all patients but four, but pain persisted in one patient. The mean ICRS score improved from 41 points (19-55 points) to 74 points (54-86 points), for an 80% gain. Follow-up MRI was available for 16 knees: the graft was hypertrophied in 11, at level in 3 and insufficient in 2; marginal integration was good in 10 knees and fair in 6. Items of marginal and subchondral integration had a very high positive predictive value for good clinical outcome. The arthroscopic score was nearly normal (range 8-11) in 8 knees and abnormal (range 4-7) in 5. The Knutsen histological groups according to richness of hyaline cartilage were: group 1 (>60%) (n=1); group 2 (>40%) (n=3), group 3 (<40%) n(=4) and group 4 (bone or fibrous tissue) (n=1). The function scores (r=0.80) and the MRI scores (r=0.76) were correlated with the arthroscopy scores. There was no correlation between the histological findings but the sample size was too small for meaningful analysis. DISCUSSION: The clinical results demonstrate an improvement in more than 80% of knees, findings similar to earlier reports. The arthroscopic and histological results were equivalent to those reported by Knutsen, but less satisfactory than those reported by Bentley or Peterson. Cell injections under a periosteal patch constitute the first generation of autologous chondrocyte grafts. Resorbable matrices loaded with chondrocytes before implantation are under development and have provided promising early results.
Asunto(s)
Enfermedades de los Cartílagos/cirugía , Cartílago Articular/cirugía , Condrocitos/trasplante , Articulación de la Rodilla/cirugía , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior , Artroscopía , Biopsia , Enfermedades de los Cartílagos/patología , Cartílago Articular/patología , Condrocitos/patología , Desbridamiento , Femenino , Estudios de Seguimiento , Humanos , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteocondritis/cirugía , Complicaciones Posoperatorias , Estudios Prospectivos , Rango del Movimiento Articular/fisiología , Trasplante AutólogoRESUMEN
Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Procedimientos Ortopédicos/estadística & datos numéricos , Ortopedia/organización & administración , Centros Traumatológicos/organización & administración , Francia , HumanosRESUMEN
Stress fracture of the hook of the hamate is uncommon and is usually seen in sports involving a club, racquet or bat (i.e., golf, tennis or baseball). It is caused by direct blunt trauma. We report an unusual case of stress fracture with non-union in a 23-year-old professional bowler, probably caused by endogenous constraints, 1 year after the start of symptoms. Treatment consisted of surgical resection of the hook of the hamate. Multimodal imaging of this fracture is reviewed.
Asunto(s)
Traumatismos en Atletas/complicaciones , Fracturas por Estrés/etiología , Hueso Ganchoso/lesiones , Fracturas por Estrés/diagnóstico por imagen , Hueso Ganchoso/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Meniscal lesion does not mean meniscectomy and this is particularly true for the lateral meniscus. The reputation of mildness of the meniscectomy is usurped. The rate of joint space narrowing after lateral meniscectomy is of 40% at a follow-up of 13 years compared to 28% for the medial meniscus (symposium SFA 1996). Several arguments explain those results: biomechanical: the lateral meniscus contributes to the congruence; particularly the lateral meniscus is the zone where antero-posterior translational during knee flexion is 12 mm. The pejorative effects of lateral meniscectomy have conducted, more though to the medial meniscus, to the concept of meniscal economy. Lateral meniscectomy must be as partial as possible. Particularly, a discoid meniscus presenting a complete tear should be treated by a meniscoplasty in order to shape the meniscus in a more anatomic form than a total meniscectomy. Lateral meniscectomy is indicated in complex or horizontal cleavage, symptomatic, on stable knees. A particular case is the cyst of the lateral meniscus. It is a cystic subcutaneous formation, usual consequence of a horizontal cleaved meniscus of which the particularity is that it opens besides the articulation. The strategy must not consist in the isolated treatment of the cyst. This pathology should be addressed by an arthroscopic meniscectomy reaching the meniscosynovial junction at the level of the cyst. Meniscal repair must be proposed every time if possible. Criteria of reparability are better studied on MRI. Preoperatively MRI is the first choice radiological exam. Two essential indications can be held back: the vertical peripheral longitudinal lesion is on the non-vascularized area, and the horizontal cleaving of the junior athlete (if the cleaving remains purely intra meniscal). Meniscal repair is highly performed when the meniscal tear is associated to a rupture of the ACL (simultaneous reconstruction of the LCA). Postoperative outcome is different of that of a "simple" arthroscopic meniscectomy. The healing process being slow, it suits to protect the suture by a splint in the first month, and with an exclusion of sports with knee torsion during 6 months. Functional results (absence of secondary meniscectomy) and anatomical results (reality of the cicatrisation) are good in 77% of cases (symposium of the French Society of Arthroscopy 2003) at a follow-up of 55 months. Survivorship analysis indicates that majority of the failures occur within two years: this testifies a default of primary cicatrisation. At the studied follow-up, meniscal repair was efficient to protect the cartilage. Lateral meniscus results are better that medial meniscus one. Those data support indications: All suspicion of meniscal lesion must have an MRI preoperatively to confirm the lesion, to localize her and to search criteria of reparability; All vertical longitudinal peripheral lesions can and must be repaired especially in young patients and children; All horizontal cleaving of the junior athletes should be treated by open repair; surgical abstention must be proposed when the lesion is non symptomatic, or when lesion is limited and associated to an ACL tear (in that case isolated ACL reconstruction is proposed), or when clinical symptoms are minimal; Meniscectomy, always arthroscopic, is proposed for a symptomatic lesion in the avascular zone or for a deep horizontal cleavage or a complex tear; Tear of the discoid meniscus should be treated by meniscoplasty. A painful knee after lateral meniscectomy might be due to a too limited initial meniscectomy: an iterative meniscectomy may be indicated or lateral femorotibial arthritis, especially after subtotal or total meniscectomy. In this last case and after failure of usual medical treatment such as viscosupplementation surgery may be indicated. Osteotomy in order to unload the lateral femorotibial compartment gives a partial response as the shearing forces remain. This osteotomy is indicated only if the lower limb axis is normal or in valgus. Meniscal allograft is an option in young patients in grade I or II arthritis. Results are promising. Rene Verdonk's series show a survivorship analysis of 75% at 7 years. Early diagnosis of a postmeniscectomy syndrome before cartilaginous lesions occur is essential for an adapted treatment. In conclusion, lateral meniscectomy are less frequent than those of the medial meniscus but their prognosis is less favorable. They should be early diagnosed (MRI). Treatment options are various: abstention, meniscectomy, and repair. Painful post lateral meniscectomy syndrome may be treated by a new surgical option: meniscal allograft.
Asunto(s)
Meniscos Tibiales , Quistes/diagnóstico , Quistes/cirugía , Humanos , Meniscos Tibiales/anomalías , Meniscos Tibiales/anatomía & histología , Meniscos Tibiales/cirugía , Procedimientos Ortopédicos/métodos , Lesiones de Menisco TibialRESUMEN
INTRODUCTION: In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. HYPOTHESIS: Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. MATERIALS AND METHODS: This multicenter, retrospective study on the outcome of cruciate ligaments at 12 years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675 arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. RESULTS: The mean follow-up was 11.9±0.8 years. The subjective IKDC score was 83.7±13. At 12 years, the rate of moderate to severe osteoarthritis l (IKDCC or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34 years (P<0.05), cartilage lesions at surgery (P<0.05), medial or lateral meniscectomy (P<0.05), and residual laxity (P<0.05). CONCLUSIONS: This large-scale study identified risk factors for osteoarthritis that should improve the information provided to patients on long-term progression after ACL reconstruction. LEVEL OF EVIDENCE: Retrospective cohort study, level IV.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Cartílago Articular/fisiopatología , Osteoartritis de la Rodilla/prevención & control , Adulto , Lesiones del Ligamento Cruzado Anterior/complicaciones , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/etiología , Osteoartritis de la Rodilla/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
Various indications exist for thumb interphalangeal and finger distal interphalangeal arthrodesis. Various fixation techniques (compression screws, tension band wiring, K-wires) have been described with fusion rates varying between 80 and 100%. The objective of this study was to evaluate the outcomes of interphalangeal arthrodesis using the X-Fuse(®) intramedullary implant in terms of fusion rate and fusion position. A continuous series of 38 arthrodesis procedures was reviewed retrospectively to determine the fusion rate and evaluate complications linked to this fixation technique. The position of the fused joint was compared to that obtained at the end of the procedure so as to evaluate the reliability of implant placement. The fusion rate was 94.8%; two arthrodeses had to be redone with satisfactory results. A moderate change of less than 10 degrees in the arthrodesis position between the immediate postoperative period and fusion was observed in the frontal and sagittal planes that had no clinical consequences. The fusion rate reported here is similar to the best rates published with other fusion techniques, and few complications occurred. Use of this intramedullary implant seems to be a viable alternative to the other techniques.
Asunto(s)
Artrodesis , Articulaciones de los Dedos/cirugía , Prótesis e Implantes , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Early treatment of initial anterior glenohumeral dislocation in young patients is controversial and the interest of surgery, and notably arthroscopic stabilization, has not been demonstrated. A prospective study was therefore performed to assess (1) short-to-medium-term recurrence rate, (2) functional outcome, and (3) and medium-term osteoarthritis rate. HYPOTHESIS: Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate. MATERIALS AND METHODS: Twenty-one patients with initial anterior dislocation were included between June 2002 and February 2004. All patients underwent arthroscopic Bankart repair within 30 days of dislocation. Patients were followed up prospectively, with clinical (Duplay and Constant scores) and radiological assessment (osteoarthritis). RESULTS: There were 5 recurrent dislocations (25%); 2 patients reported sensations of subluxation: i.e., 7 failures (35%). Mean Walch-Duplay score at 10 years was 88±1 (range, 30-100) and mean Rowe score 86±22 (range, 35-100). There was significant internal rotation deficit of one vertebral level between operated and contralateral shoulder (P < 0.005). At 10 years, 3 shoulders (15%) showed Samilson grade 1 centered glenohumeral osteoarthritis. CONCLUSION: Early arthroscopic capsule-labrum reinsertion by the Bankart technique in the month following initial anterior dislocation of the shoulder in patients under 25 years of age provided a low recurrence rate (35%) compared to the literature, including dislocation (25%) and subluxation (10%). Functional outcome was satisfactory, and osteoarthritis rate was low (15% Samilson grade 1). LEVEL OF EVIDENCE: IV, prospective non-comparative study.
Asunto(s)
Osteoartritis/diagnóstico por imagen , Luxación del Hombro/cirugía , Adolescente , Adulto , Amputación Quirúrgica , Artroplastia/métodos , Artroscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis/etiología , Osteoartritis/cirugía , Estudios Prospectivos , Radiografía , Recurrencia , Rotación , Hombro/cirugía , Luxación del Hombro/complicaciones , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Insuficiencia del Tratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
This study related mechanisms of gait compensations to the level of pain and to limitations in passive motion in patients with osteoarthritis of the hip. Joint motion, moments, and intersegmental forces were calculated for 19 patients with unilateral osteoarthritis of the hip (12 men and seven women) and for a group of normal subjects (12 men and seven women) with a similar age distribution. The patients who had osteoarthritis walked with a decreased dynamic range of motion (17 +/- 4 degrees) of the hip and with a hesitation or reversal in the direction of the sagittal plane motion as they extended the hip. The patients with a hesitation or reversal in motion had a greater loss in the range of motion of the hip during gait (p < 0.004) and a greater passive flexion contracture (p < 0.022) than those with a smooth pattern of hip motion. This alteration in the pattern of motion was interpreted as a mechanism to increase effective extension of the hip during stance through increased anterior pelvic tilt and lumbar lordosis. The patients who had osteoarthritis of the hip walked with significantly decreased external extension, adduction, and internal and external rotation moments (p < 0.008). The decreased extension moment was significantly correlated with an increased level of pain (R = 0.78; p < 0.001). This finding suggests that decreasing muscle forces (hip flexors) may be one mechanism used to adapt to pain.
Asunto(s)
Marcha , Articulación de la Cadera/fisiopatología , Osteoartritis de la Cadera/fisiopatología , Dolor/fisiopatología , Anciano , Fenómenos Biomecánicos , Femenino , Humanos , Cinética , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Movimiento/fisiología , Osteoartritis de la Cadera/complicaciones , Dolor/etiologíaRESUMEN
We reviewed 74 partial medial meniscectomies in 57 patients with stable knees, to assess the long-term functional and radiological outcome. The International Knee Documentation Committee score and the residual laxity were assessed in both knees. At the time of surgery the mean age of the patients was 36 +/- 11 years and the mean follow-up was 12 +/- 1 years. All had a limited medial meniscectomy. The anterior cruciate ligament was intact in all cases. The meniscal tear was vertical in 95% and complex in 5%. The posterior part of the meniscus was removed in 99%. A peripheral rim was preserved in all cases. After 12 years 95% of the patients were satisfied or very satisfied with their knee(s). Objectively, 57% had grade A function and 43% were grade B. The outcome correlated only with the presence of anterior knee pain at final follow-up. In the 49 cases of arthroscopic meniscectomy for which there was a contralateral normal knee there was narrowing of the 'joint-space' in 16% of the operated knees. There was no correlation between this and other parameters such as age or different meniscal pathologies.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación/cirugía , Traumatismos de la Rodilla/cirugía , Lesiones de Menisco Tibial , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Meniscos Tibiales/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular/fisiología , Resultado del TratamientoRESUMEN
Effects of season, nutritional environment, and presence of rams on incidence and rate of ovulation in fine-wool sheep in southern New Mexico were investigated over 14 months (February 1983-March 1984). Number of corpora lutea (CL) were observed each month by laparoscopy in random samples from six ewes in each subgroup. Seasonality of ovulation in fine-wool sheep managed on range was much more marked than in animals managed on alfalfa hay in drylot. Incidence of ovulation approached zero in range-managed ewes during May, June, and July (8%, 0%, 4%) but was higher (P<0.05) in the alfalfa-drylot group (42%, 17%, 75%), respectively. Although the incidence remained lower (P<0.05) in August in range-managed than in drylot ewes (50% and 83%, respectively), both groups were ovulating at a high rate during September through January. Incidence of ovulation dropped dramatically both years in the range-managed group in February compared with that of the alfalfa-drylot group (48% and 36% vs 100% and 83%). Mean ovulation rate per ewe ovulating did not differ (P>0.10) between nutrition groups within the 14 months. Body weight was related to CL number during periods of seasonal transition only. Continuous or intermittent presence of a ram had no real effect on either incidence or rate of ovulation during the transitional months. Nutritional environment can affect seasonality of breeding in fine-wool range sheep. This effect may not be consistently modified by presence of rams.
RESUMEN
Effects of season and supplementation on the incidence and rate of ovulation and hormone profiles in multiparous, nonlactating ewes were investigated under range and drylot conditions during anestrus (February through August). Ninety ewes received one of six nutritional treatments: 1) range forage, 2) range forage plus 0.33 kg.hd(-1).d(-1) pinto beans, 3) 0.45 kg.hd(-1).d(-1) alfalfa pellets, 4) dry lot plus 1.33 kg.hd(-1).d(-1) prairie hay only, 5) pinto beans or 6) alfalfa pellets at rates used on the range and prairie hay. Supplemented ewes were heavier (P < 0.05) than ewes fed range forage or prairie hay during most of the study. Seasonality of ovulation, in terms of incidence and rate, was not affected (P > 0.40) by supplementation in range ewes. The ovulation rate tended to be highest in prairie hay plus pinto bean drylot ewes in February (P = 0.21) and in prairie hay plus alfalfa pellet and prairie hay plus pinto bean ewes in March (P = 0.13) compared with prairie hay ewes. Generally, seasonality of ovulation was not influenced by supplementation (P > 0.40). The incidence of ovulation approached zero for drylot ewes in April, May, June and July, while it was 43, 27, 35 and 21% for range ewes, in those same months. Supplementation did not affect serum progesterone during the estrous cycle. Luteinizing hormone (LH) concentrations were similar (P > 0.50) among drylot treatment groups before a 50-ug gonadotropin releasing hormone (GnRH) challenge. Pinto bean supplementation enhanced serum LH response to GnRH (P < 0.10).
RESUMEN
Development of the Polypay breed was undertaken to combine into a composite breed the potential for greatly increased reproductive capacity along with desirable growth rate and carcass quality. Four breeds were selected for the foundation of the new breed--the Rambouillet and the Targhee for hardiness, large body size, long breeding season, herding instinct and fleece characteristics; the Dorset for carcass quality, milking ability and long breeding season and the Finnsheep for early puberty, early postpartum fertility and high lambing rate. Dorset X Targhee and Finnsheep X Rambouillet matings were first made in 1968, and reciprocal Dorset-Targhee X Finn-Rambouillet matings were initiated in 1969. Beginning in 1970, the respective two-breed crosses and the four-breed cross (Polypay) were each mated inter se and selected, along with straightbred Rambouillets and Targhees, for lamb production when given two opportunities to lamb/year. Initial comparisons among straightbreds and inter se mated groups showed few important differences in meat-type body conformation, body condition or growth rate, but superior annual reproductive performance by Polypays. Fertility of Polypays at 1 yr of age was high and comparable to that of the Finn-Rambouillets. Response of Polypays to twice-a-year lambing was superior to responses of Rambouillets. Targhees, Dorset-Targhees or Finn-Rambouillets. The 1974 to 1975 annual production of young Polypays was about 13% more lambs weaned than from Finn-Rambouillets and 18% more weight of lamb weaned than from Dorset-Targhees, the best of the other groups for these traits. The current (1979 to 1981) reproductive performance of Polypay ewes selected for high once-a-year lambing rate under typical range management conditions is very competitive with that of 1/2 Finn crossbreds. Annual production of mature Polypays on the twice-a-year lambing schedule was 1.78 lambs weaned and 58.6 kg of lamb weaned/ewe put into fall breeding.
Asunto(s)
Cruzamiento , Reproducción , Ovinos/genética , Animales , Peso Corporal , Cruzamientos Genéticos , Femenino , Masculino , Ovinos/fisiología , Destete , Lana/crecimiento & desarrolloRESUMEN
A debilitating condition affecting mature ewes was found to be associated with the visceral form of caseous lymphadenitis, chronic progressive pneumonia, and Corynebacterium pyogenes infections. The condition was termed thin ewe syndrome. Affected and normal ewes were compared for reproductive efficiency by breed and age; differences in reproductive efficiency between affected and normal Rambouillet and Columbia ewes were highly significant (P less than 0.01). Although not statistically significant, the trend in Targh ee ewes was similar. There was a direct correlation between occurence of the syndrome and increasing age for all breeds.