RESUMO
BACKGROUND: Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. METHODS: This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. RESULTS: A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was - 2.26 and - 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. CONCLUSION: Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. TRIAL REGISTRATION: This trial is registered at ClinicalTrails.gov ( https://clinicaltrials.gov/ ) on the 25th of October 2006: NCT00391937. LEVEL OF INCIDENCE: Level IIb, multicenter randomized controlled trial.
Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Cirurgia Assistida por Computador/métodos , Adulto , Artroplastia de Quadril/instrumentação , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Período Pós-Operatório , Radiografia , Método Simples-Cego , Cirurgia Assistida por Computador/instrumentaçãoRESUMO
The purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all, 21 hips (68%) had grade III or IV femoral defects according to the Endo-Klinik classification. A total of 11 patients (12 hips) died before the ten-year follow-up period. Of the remaining patients, 18 patients (19 hips) were followed for 10 to 15 years; three further patients died during this time. None of the 31 stems underwent further revision of their stem. However, four stems showed extensive subsidence (> 15 mm). One of these patients had a femoral fracture that required fixation. Three other patients had a femoral fracture, two of which required fixation and the other was treated conservatively. Patients with a femoral fracture and/or severe subsidence had significantly more grade IV defects (six of seven hips; p = 0.004). One patient needed a closed reduction for dislocation. Impaction allografting in revision hip surgery gives good long-term results for femora with grades I, II and III Endo-Klinik-classified defects. Extensive subsidence and femoral fractures were seen mainly in patients with grade IV damaged femora.
Assuntos
Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Fêmur/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Transplante Ósseo/efeitos adversos , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/prevenção & controle , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/prevenção & controle , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Reoperação/métodosAssuntos
Epifise Deslocada/etiologia , Cabeça do Fêmur/fisiopatologia , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Acidentes por Quedas , Adolescente , Carcinoma Neuroendócrino , Epifise Deslocada/diagnóstico por imagem , Epifise Deslocada/cirurgia , Feminino , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Quadril/diagnóstico por imagem , Quadril/patologia , Quadril/fisiopatologia , Lesões do Quadril/diagnóstico por imagem , Humanos , Pescoço , Neurofibroma/etiologia , Dor/etiologia , Radiografia , Biópsia de Linfonodo Sentinela , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations.
Assuntos
Transplante Ósseo/métodos , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Adulto , Idoso , Artrodese , Transplante Ósseo/efeitos adversos , Transplante Ósseo/psicologia , Feminino , Seguimentos , Humanos , Ílio/transplante , Incidência , Instabilidade Articular/psicologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Recidiva , Luxação do Ombro/psicologia , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the clinical results of conversion of an arthrodesis of the hip to a total hip arthroplasty (THA) at the Erasmus MC, Rotterdam, the Netherlands. DESIGN: Retrospective study. METHOD: Data were collected from the case notes of patients who had undergone conversion ofarthrodesis of the hip to a total hip prosthesis between 1 January 1985 and 31December 2003. This was a total of 13 patients, 1 of whom had died and 2 of whom were excluded because of dementia and severe psychiatric disorder respectively. The remaining 10 patients (5 men and 5 women) were sent the Short form-36 quality-of-life questionnaire and asked, if, in hindsight, they would undergo the operation again. Their hip function was assessed using the Harris Hip Score (HHS) and the weakness of the gluteus muscles using Trendelenburg's test. The preoperative and most recent postoperative X-rays of the pelvis were evaluated. RESULTS: Median age at the time ofTHA was 45 years (range: 21-62). THA was done median 15 years (range: 2-50) after arthrodesis. Follow-up was done median 5 years (range: 0-18) after THA. The main reasons for conversion were ipsilateral knee pain and low back pain, which both improved after conversion. The median HHS was 75.0 (range: 44.7-99.4) and the Trendelenburg test was positive in 5 patients. 6 patients had heterotopic ossification without limitation in joint range. 9 patients confirmed they would undergo the operation again. CONCLUSION: Arthrodesis ofthe hip was a reasonable treatment option for young patients with monoarticular hip disease.
Assuntos
Artrodese , Artroplastia de Quadril/psicologia , Articulação do Quadril/cirurgia , Satisfação do Paciente , Adulto , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Fatores de TempoRESUMO
We report the initial results of an ongoing randomised, prospective study on migration of the Exeter and Elite Plus femoral stems after impaction allografting, as measured by radiostereometry. Clinically, the impaction technique gave good results for both stems. The mean subsidence in the first year was 1.30 mm and 0.20 mm for the Exeter and the Elite Plus stems, respectively. In the second year, the Exeter stem continued to subside further by a mean of 0.42 mm, while the Elite Plus stem did not do so. Subsidence of the Exeter stem correlated with deficiency of bone stock as graded on the Gustilo and Pasternak scale. This correlation was not found for the Elite Plus stem. None of the other parameters which were studied predisposed to subsidence. There was no significant association between the amount of subsidence and the radiological appearance of the graft for either stem. Our findings do not support the theory that radial compression, due to subsidence of the Exeter stem, is the essential stimulus for remodelling in impaction allografting.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Migração de Corpo Estranho/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesos e Medidas Corporais/métodos , Remodelação Óssea , Transplante Ósseo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , RadiografiaRESUMO
We analyzed the results of eleven shoulders in ten patients who had a bone block procedure for recurrent posterior shoulder instability after extensive conservative treatment had failed. Five patients had posterior instability with additional laxity in another direction (UPI+), and five patients had unidirectional posterior instability without additional laxity (UPI-). After a median follow-up of 72 (43-102) months there was no recurrent posterior instability in the UPI-group (100% success), but the recurrence rate in the UPI+ group was high (20% success). We concluded from these results that a bone block procedure is not sufficient to treat recurrent posterior shoulder instability in unidirectional posterior instability with additional laxity but it seems to be a good method to treat unidirectional posterior instability without additional laxity.
Assuntos
Instabilidade Articular/cirurgia , Procedimentos Ortopédicos , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Ílio/transplante , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular , Recidiva , Resultado do TratamentoRESUMO
We performed a prospective study to evaluate the application of impacted allograft bone particles at revision surgery of severely defective femora. According to the Endo-Klinik classification, 21 hips had grade III or IV femoral defects, of which 4 had a preoperative fracture. No femoral re-revisions had been necessary after a mean follow-up of 60 (41-85) months. The mean Harris Hip Score improved by 39 points to 78 points. 2 fractures occurred postoperatively, 1 of which needed reoperation with osteosynthesis. 1 patient needed a closed reduction after dislocation. 4 stems showed significant subsidence (> 10 mm) in the follow-up radiographs. In total hip revision surgery, even severely damaged femora can be successfully treated by impaction allografting.
Assuntos
Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Fêmur/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Remodelação Óssea , Feminino , Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Estudos Prospectivos , Falha de Prótese , Radiografia , Índice de Gravidade de Doença , Transplante Homólogo/métodos , Resultado do TratamentoRESUMO
Progressive walking difficulties and bladder dysfunction may be attributed to Alzheimer disease or atlanto-axial subluxation in people with Down's syndrome (DS). The present authors describe five patients with DS suffering from the above symptoms as a result of cervical spondylarthrotic myelopathy. Clinical and radiological data were collected from all patients with DS who underwent surgery for cervical spondylarthrotic myelopathy at the Leiden University Medical Centre during the period between 1991 and 1995. Five patients with DS (four males and one female) were identified. Their mean age at diagnosis was 42 years. The main clinical features were weakness of the arms and legs, ataxic gait, hyperreflexia and bilateral Babinski signs. Radiological examination showed spondylarthrosis, compression of the spinal cord and myelomalacia. The mean delay in diagnosis was 3 years. All five individuals showed clinical stabilization after laminectomy. Cervical spondylarthrotic myelopathy seems a rather frequent disorder in DS, occurring at a relatively young age. Early diagnosis may prevent irreversible neurological deficits.
Assuntos
Vértebras Cervicais , Síndrome de Down/diagnóstico , Compressão da Medula Espinal/diagnóstico , Espondilite Anquilosante/diagnóstico , Adulto , Diagnóstico por Imagem , Síndrome de Down/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Fatores de Risco , Compressão da Medula Espinal/genética , Espondilite Anquilosante/genéticaRESUMO
OBJECTIVE: The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. DESIGN: Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. RESULTS: Digital subtraction arthrography was best (P < 0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P = 0.24) and scintigraphy (P = 0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P = 0.001), while the plain radiograph was of significant (P = 0.04) additional value and scintigraphy was of no additional value (P = 0.13) on multivariate analysis. CONCLUSION: Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.
Assuntos
Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril , Dor/etiologia , Intensificação de Imagem Radiográfica , Técnica de Subtração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Cintilografia , ReoperaçãoRESUMO
A follow-up study was performed to assess the prevalence of scoliosis in 160 patients in whom aortic coarctation had been treated operatively through a left posterolateral incision in the fourth intercostal space. Scoliosis had not been seen in any patient before the thoracotomy, but a scoliosis of 10 degrees or more was observed in thirty-five patients (22 per cent) at the follow-up examination, which was performed an average of seven years after the thoracotomy. The scoliosis was a thoracic curve and was directed to the left in twenty-six of the thirty-five patients. Most of the curves were mild (between 10 and 20 degrees) and hardly progressed during the follow-up period. The high-risk period for the onset of scoliosis began about three years after the operation. The prevalence of scoliosis did not correlate significantly with the age or sex of the patients.