Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review.

Primary pyomyositis is a deep bacterial infection of the skeletal muscle. If left undiagnosed and untreated, the infection spreads, leading to sepsis, septic shock, and even death. The authors report a 23-year-old female presenting with piriformis pyomyositis during a treatment for Kikuchi-Fujimoto disease. Pyomyositis is a rare but potentially severe infection, which can lead to septic shock. The present case shows the need for a high degree of clinical suspicion for patients with compromised immune systems to begin treatment at an early stage. The literature demonstrates that outcomes of the treatment of piriformis pyomyositis are good.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty.

Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hip were evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with a mean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant ( p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant ( p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty / Recuperação do centro de rotação do quadril com tântalo em artroplastias de revisão

Abstract Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hipwere evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with amean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant (p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant (p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril comuso de tântalo entre o período de junho de 2013 e abril de 2017. Foramavaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componenteao centro de rotação anatômicodoquadril.Asmedidas foramrealizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pósoperatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p < 0,001). Conclusão As revisões de artroplastia do quadril comcopas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.

Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease - A Case Report and Literature Review / Piomiosite do piriforme em um paciente com doença de Kikuchi-Fujimoto-relato de caso e revisão da literatura

Abstract Primary pyomyositis is a deep bacterial infection of the skeletal muscle. If left undiagnosed and untreated, the infection spreads, leading to sepsis, septic shock, and even death. The authors report a 23-year-old female presenting with piriformis pyomyositis during a treatment for Kikuchi-Fujimoto disease. Pyomyositis is a rare but potentially severe infection, which can lead to septic shock. The present case shows the need for a high degree of clinical suspicion for patients with compromised immune systems to begin treatment at an early stage. The literature demonstrates that outcomes of the treatment of piriformis pyomyositis are good.

Resumo A piomiosite primária é uma infecção bacteriana profunda do músculo esquelético. Quando não diagnosticada ou tratada, a infecção pode evoluir para sepse, choque séptico e até morte. Os autores relatam o caso de uma paciente do sexo feminino, 23 anos, apresentando piomiosite do músculo piriforme durante o tratamento da doença de Kikuchi-Fujimoto. A piomiosite é uma infecção rara, mas potencialmente grave, que pode levar ao choque séptico. Esse caso mostra a necessidade em se elevar o grau de suspeição clínica em pacientes com comprometimento do sistema imunológico, para que o tratamento seja iniciado em estágio precoce. A literatura mostra que os resultados do tratamento da piomiosite do piriforme são bons.

Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment.

Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition.

A sinovite vilonodular pigmentada é uma rara condição proliferativa da membrana sinovial. Apesar de a doença poder estar presente em qualquer articulação, o joelho é o local mais frequentemente afetado. Ainda que doença benigna, geralmente tem comportamento agressivo, pode ter extensão extra-articular em alguns casos. O acometimento monoarticular ocorre em duas formas: localizada ou difusa. A forma difusa é mais comum e tem alta taxa de recorrência. Não há método padronizado para o manejo dessa lesão. O tratamento cirúrgico aberto é o método clássico e efetivo. A sinovectomia artroscópica, entretanto, tem ganhado popularidade e tem diversas vantagens sobre a técnica aberta, principalmente em casos exclusivamente articulares. A abordagem combinada é sugerida em casos com envolvimento extra-articular. A sinovectomia pode prevenir a osteoartrose secundária e o subsequente tratamento reconstrutivo. A radioterapia usada como tratamento adjuvante à sinovectomia parece diminuir a taxa de recorrência local na forma difusa da doença. Os autores encontraram grande heterogeneidade na forma como os resultados funcionais foram reportados e não se deve chegar a conclusões específicas. Cada paciente deve ser manejado de acordo com suas particularidades.

Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment / Sinovite vilonodular pigmentada difusa no joelho: diagnóstico e tratamento

ABSTRACT Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition.

RESUMO A sinovite vilonodular pigmentada é uma rara condição proliferativa da membrana sinovial. Apesar de a doença poder estar presente em qualquer articulação, o joelho é o local mais frequentemente afetado. Ainda que doença benigna, geralmente tem comportamento agressivo, pode ter extensão extra-articular em alguns casos. O acometimento monoarticular ocorre em duas formas: localizada ou difusa. A forma difusa é mais comum e tem alta taxa de recorrência. Não há método padronizado para o manejo dessa lesão. O tratamento cirúrgico aberto é o método clássico e efetivo. A sinovectomia artroscópica, entretanto, tem ganhado popularidade e tem diversas vantagens sobre a técnica aberta, principalmente em casos exclusivamente articulares. A abordagem combinada é sugerida em casos com envolvimento extra-articular. A sinovectomia pode prevenir a osteoartrose secundária e o subsequente tratamento reconstrutivo. A radioterapia usada como tratamento adjuvante à sinovectomia parece diminuir a taxa de recorrência local na forma difusa da doença. Os autores encontraram grande heterogeneidade na forma como os resultados funcionais foram reportados e não se deve chegar a conclusões específicas. Cada paciente deve ser manejado de acordo com suas particularidades.

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete.

INTRODUCTION: Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. CASE REPORT: This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. CONCLUSION: This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up.