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Article in Chinese | WPRIM | ID: wpr-1009231


The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Child , Humans , Osteochondritis Dissecans , Treatment Outcome , Follow-Up Studies , Knee Joint/surgery , Menisci, Tibial/surgery , Joint Diseases/surgery , Prognosis , Cartilage Diseases/surgery , Meniscus , Pain, Postoperative , Arthroscopy/methods
Braz. j. infect. dis ; 21(6): 613-619, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-888916


ABSTRACT Purposes: Shoulder arthroplasty (SA) has been performed by many years for the treatment of several conditions, including osteoarthritis and proximal humeral fractures following trauma. Surgical site infection (SSI) following Shoulder arthroplasty remains a challenge, contributing to increased morbidity and costs. Identification of risk factors may help implementing adequate strategies to prevent infection. We aimed to identify pre- and intra-operative risk factors associated with deep infections after Shoulder arthroplasty. Methods: An unmatched case-control study was conducted to describe the prevalence, clinical and microbiological findings, and to evaluate patient and surgical risk factors for prosthetic shoulder infection (PSI), among 158 patients who underwent SA due to any reason, at a tertiary public university institution. Risk factors for PSI was assessed by uni- and multivariate analyses using multiple logistic regression. Results: 168 SA from 158 patients were analyzed, with an overall infection rate of 9.5% (16/168 cases). Subjects undergoing SA with American Society of Anesthesiologists (ASA) grade III or higher (odds ratio [OR] = 5.30, 95% confidence interval [CI] = 1.58-17.79, p < 0.013) and presenting local hematoma after surgery (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.09-46.09, p = 0.04) had higher risk for PSI on univariate analysis. However, only ASA score grade III or higher remained significant on multivariate analysis (OR = 4.74, 95% CI = 1.33-16.92, p = 0.016). Gram-positive cocci and Gram-negative bacilli were equally isolated in 50% of cases; however, the most commonly detected bacterium was Pseudomonas aeruginosa (18.7%). Conclusion: This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.

Humans , Female , Middle Aged , Aged , Aged, 80 and over , Shoulder Joint/surgery , Prosthesis-Related Infections/microbiology , Arthroplasty, Replacement/adverse effects , Joint Diseases/surgery , Joint Prosthesis/microbiology , Shoulder Joint/microbiology , Case-Control Studies , Logistic Models , Retrospective Studies , Risk Factors
Acta ortop. mex ; 31(5): 233-238, sep.-oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-886573


Resumen: Antecedentes: La «artrólisis¼ abierta ha sido el tratamiento estándar en la rigidez de codo, con buenos resultados; sin embargo, las complicaciones asociadas y los avances en la cirugía artroscópica han permitido incorporar esta técnica quirúrgica. Material y métodos: Entre Enero de 2014 y Marzo de 2016, seis pacientes con rigidez postraumática de codo fueron intervenidos mediante cirugía artroscópica por el mismo equipo quirúrgico. Se registró pre- y postoperatoriamente, el nivel de dolor según escala analógica visual numérica, rango de movilidad articular del codo con el uso de un goniómetro y cuestionario Mayo Elbow Performance Index. Resultados: El seguimiento medio de los pacientes fue de 14.5 meses. El valor medio en la escala analógica visual disminuyó de 4.5 a 0.3 puntos. El rango medio de movilidad del codo se incrementó de 55.3o a 130o, con una ganancia media de 75o. La puntuación media en el cuestionario MEPI pasó de 46.6 puntos a 95 puntos, con una ganancia media de 48.4 puntos. Como procedimientos asociados a la «artrólisis¼ artroscópica se realizó extracción del material de síntesis en las tres fracturas de olécranon. No hubo ningún caso de osificación heterotópica, infección superficial o neuropatía cubital. Ningún paciente precisó reintervención quirúrgica para una nueva «artrólisis¼ artroscópica o abierta. Conclusiones: La liberación artroscópica en la rigidez postraumática de codo es una técnica efectiva a corto plazo para recuperar la movilidad.

Abstract: Background: Open «arthrolysis¼ has been the standard treatment for elbow stiffness, with good results. However, the associated complications of open arthrolysis and the advancements in arthroscopic surgery have allowed including the latter as an additional approach. Material and methods: Between January 2014 and March 2016, 6 patients with posttraumatic elbow stiffness underwent arthroscopic surgery by the same surgical team. Pre- and post-operative assessment included pain with a numerical visual analogue scale, elbow joint range of motion with a goniometer and the Mayo Elbow Performance Index questionnaire. Results: Mean patient follow-up was 14.5 months. The mean VAS score decreased from 4.5 to 0.3. The mean elbow range of motion increased from 55.3o to 130o, with a mean gain of 75o. The mean MEPI questionnaire score went from 46.6 to 95, with a mean gain of 48.4 points. The procedures associated with arthroscopic «arthrolysis¼ included removal of the synthesis material from the 3 olecranon fractures. No cases of heterotopic ossification, superficial infection or ulnar neuropathy were reported. None of the patients required surgical reintervention to perform a new «arthrolysis¼, whether arthroscopic or open. Conclusions: Arthroscopic release to treat posttraumatic elbow stiffness is an effective technique to restore mobility in the short term.

Humans , Arthroscopy , Range of Motion, Articular , Elbow Joint/injuries , Joint Diseases/surgery , Treatment Outcome
Rev. cuba. ortop. traumatol ; 31(1): 12-23, ene.-jun. 2017. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-901399


Objetivo: Desarrollar criterios para determinar las indicaciones apropiadas de la prótesis invertida de hombro en artropatías por lesión del manguito rotador y las variables determinantes de este proceso. Método: Se utilizó un panel de expertos mediante metodología RAND/UCLA con 9 expertos en Traumatología, 2 en Rehabilitación y 1 en Reumatología, que evaluaron 192 casos hipotéticos. Cada experto puntuó mediante una escala del 1 (extremadamente inadecuado) al 9 (extremadamente apropiado). Resultados: 22 casos hipotéticos fueron considerados adecuados. El dolor, limitación funcional, necesidad funcional, defecto glenoideo, edad, artrosis y posibilidad de reparación del manguito rotador son variables determinantes para indicar la implantación de una prótesis invertida de hombro. Conclusiones: El método RAND/UCLA es útil para el estudio de las indicaciones de procedimientos como la prótesis invertida de hombro, y proporciona una lista de las indicaciones adecuadas. Las variables requieren ser validadas mediante estudios prospectivos o revisión de historias clínicas(AU)

Objective: Develop criteria to determine the appropriate indications of inverted shoulder prosthesis in arthropathies due to rotator cuff injury and the variables that determine this process. Method: A panel of experts assessed 192 hypothetical cases using RAND/UCLA methodology. Nine Traumatology experts, two Rehabilitation experts and one Rheumatology expert comprised this panel. Each expert scored on a scale from 1 (extremely unsuitable) to 9 (extremely appropriate). Results: 22 hypothetical cases were considered adequate. Pain, functional limitation, functional need, glenoid defect, age, osteoarthritis and possibility of rotator cuff repair are determining as variables to indicate the implantation of an inverted shoulder prosthesis. Conclusions: The RAND/UCLA method is useful for the study of procedure indications such as the inverted shoulder prosthesis, and it provides a list of suitable indications. Prospective studies or medical record reviews should validate these variables(AU)

Objectif: Proposer les critères définissant l'indication appropriée de prothèse d'épaule inversée dans les arthropathies pour lésion de la coiffe des rotateurs, et les variables déterminant ce processus. Méthodes: Un panel d'experts, compris par 9 traumatologues, 2 kinésithérapeutes et 1 rhumatologue, a été utilisé pour évaluer 192 cas hypothétiques par la méthode RAND/UCLA. Chaque expert a fait son évaluation sur une échelle de 1 (extrêmement inapproprié) à 9 (extrêmement approprié). Résultats: Vingt-deux cas hypothétiques ont été considérés comme appropriés. Des variables telles que la douleur, la limitation fonctionnelle, la nécessité fonctionnelle, le défaut glénoïdien, l'âge, l'arthrose et la possibilité de correction de la coiffe des rotateurs, ont déterminé l'indication de prothèse d'épaule inversée. Conclusions: La méthode RAND-UCLA est utile pour l'étude des indications de procédés, tels que la prothèse d'épaule inversée, et procure une liste des indications appropriées. Il faut valider les variables avec des études prospectives ou une révision des dossiers médicaux(AU)

Humans , Risk Factors , Rotator Cuff Injuries/etiology , Shoulder Prosthesis , Joint Diseases/surgery
Acta ortop. mex ; 31(1): 24-29, ene.-feb. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-886530


Resumen: Antecedentes: El dolor crónico de la región posterior del tobillo es generalmente debido a un conflicto entre estructuras capsuloligamentares y óseas. La presencia del os trigonum o una apófisis posterior del astrágalo pronunciada puede ocasionar por sí sola este pinzamiento. El propósito de este estudio es mostrar los resultados de la endoscopía del retropié por un pinzamiento posterior del tobillo. Material y métodos: Veinticuatro pacientes con diagnóstico de síndrome de pinzamiento posterior del tobillo fueron operados mediante técnica artroscópica posterior en el período comprendido entre 2008 y 2012. Se analizaron como variables el tipo de deporte, nivel deportivo según clasificación CLAS y retorno a la actividad deportiva. Fueron valorados según la EVA del dolor y las escalas AOFAS, SFMCP (Société Française de Médecine et Chirurgie du Pied) para el tobillo, y se evaluó la satisfacción personal con escala de Likert. Resultados: El seguimiento promedio fue de 27.13 ± 5.26 meses, con edad promedio de 31.8 ± 5.26 años; 19 fueron masculinos (79.2%) y cinco femeninos (20.8%). La valoración del dolor con EVA 5.75 pasó a 0.95; la valoración funcional mediante una escala AOFAS preoperatoria 76.22 ± 5.29 puntos aumentó a 97.21 ± 1.96 puntos y la escala SFMCP preoperatoria 77.16 ± 3.53 puntos subió a 98.54 ± 1.38 puntos. Se registró una inmovilización en promedio de 19.75 ± 2.48 días y un retorno a la actividad deportiva en promedio de 4.6 meses (± 1.27), con 66.7% (16 individuos) muy satisfechos, 29.2% (siete) satisfechos y 4.2% (uno) regularmente satisfecho. Se encontró un caso (4.2%) de distrofia simpático refleja como complicación y otro con eritema en el portal endoscópico. Conclusión: El conflicto posterior del tobillo es una patología cuyo diagnóstico es clínico y está muy relacionado con la presencia de unos trigonum o un proceso de Stieda grande, lo cual repercute con la actividad deportiva. El tratamiento artroscópico es una opción ideal para dicha patología por la adecuada evolución clínica y estética, así como un pronto retorno a una actividad deportiva.

Abstract: Background: Chronic pain on the posterior portion of the ankle is often due to posterior impingement between bony or soft tissue structures. The presence of an os trigonum or a prominent posterior apophysis of the talus can produce this impingement. The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with a diagnosis of posterior ankle impingement. Material and methods: We studied 24 individuals who underwent a posterior ankle endoscopic procedure during the period between 2008 and 2012, with the diagnosis of posterior ankle impingement. We analyzed variables such as: sport, level of sports activity according to the CLAS classification, return to sport. All patients were classified in accordance to the AOFAS and SFMCP (Société Française de Médecine et Chirurgie du Pied) scores for ankle pathology. We measured patient satisfaction to the procedure with the Linkert scale. Results: The average follow-up was 27.13 ± 5.26 months. The average age of our patients was 31.8 ± 5.26 years. We had 19 male (79.2%) and five female (20.8%) patients. The average preoperative Visual Analog Scale of pain (VAS) 5.75 and postoperative was 0.95. The average preoperative AOFAS scale of 76.22 ± 5.29 rose to 97.21 ± 1.96. The average preoperative SFCMP scale of 77.16 ± 3.53 became 98.54 ± 1.38. Our patients had their ankles immobilized for an average of 19.75 ± 2.48 days. They returned to their sports activities at an average of 4.6 (± 1.27) months. Our patients rated their personal satisfaction as very satisfied in 16 cases (66.7%), satisfied in seven cases (29.2%), regular satisfaction in one case (4.2%). One patient developed a complex regional pain syndrome that was resolved with physical therapy and another had a wound erythema. Conclusion: The posterior ankle impingement is a pathology which diagnosis is mainly clinical, it is greatly associated with an os trigonum or a large Stieda process. It has a strong repercussion in the sports activities of the patients. The arthroscopic treatment is an ideal option for this pathology as it presents a good postoperative recovery with a swift return to patients preoperative sports activities.

Humans , Male , Female , Adult , Arthroscopy , Ankle Joint/surgery , Ankle Joint/pathology , Treatment Outcome , Endoscopy , Joint Diseases/surgery
Article in English | WPRIM | ID: wpr-69226


BACKGROUND: Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. METHODS: Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. RESULTS: Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. CONCLUSIONS: Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Adult , Female , Humans , Male , Middle Aged , Young Adult , Arthroscopy , Hip Joint , Joint Diseases/surgery , Retrospective Studies , Tenotomy/methods
Article in English | WPRIM | ID: wpr-104700


This study was conducted to assess the effects of femoral varus osteotomy on joint congruency in dogs affected by early stage hip dysplasia. Preoperative planning to move the femoral head within the acetabulum was carried out. Varisation of the femoral inclination angle (fIA) was achieved by Intertrochanteric Osteotomy (ITO). Norberg angle (NA), percent coverage (PC) of the femoral head by the acetabulum and fIA was measured from preoperative, immediate postoperative and first and second recheck radiographs of seven dogs that underwent an ITO (joint n = 9). There was significant (p < 0.05) improvement of both NA and PC in all patients as indicated by a change in the mean +/- standard deviation of 78.9degrees +/- 7.5 and 36.9% +/- 5.2 to 92.2degrees +/- 6.7 and 50.6% +/- 8.3, respectively. No significant difference (p < 0.05) was observed between the values of the planned femoral inclination angle (pfIA) of the femur and the effective femoral inclination angle (efIA) obtained after surgery (115.9degrees +/- 2.5 and 111.3degrees +/- 6.4, respectively). These findings could encourage the use of ITO in veterinary practice and indicate that intertrochanteric varus osteotomy should be re-considered for the treatment of early stage hip dysplasia in dogs with radiological signs of joint incongruency.

Animals , Dogs , Female , Male , Femur Head/surgery , Hip Dislocation/surgery , Joint Diseases/surgery , Osteotomy/methods , Radiographic Image Interpretation, Computer-Assisted/methods
Oman Medical Journal. 2013; 28 (6): 448-449
in English | IMEMR | ID: emr-142968


Ochronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis.

Humans , Female , Ochronosis/surgery , Arthroplasty, Replacement, Knee , Alkaptonuria/complications , Review Literature as Topic , Joint Diseases/surgery , Treatment Outcome
Article in English | WPRIM | ID: wpr-206710


BACKGROUND: To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. METHODS: We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. RESULTS: Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. CONCLUSIONS: Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Activities of Daily Living/psychology , Arthroscopy/psychology , Joint Diseases/surgery , Patient Satisfaction , Perioperative Period/psychology , Prospective Studies , Surveys and Questionnaires , Republic of Korea , Rotator Cuff/surgery , Shoulder/surgery , Shoulder Pain/etiology , Stress, Psychological/etiology
Article in English | WPRIM | ID: wpr-102719


BACKGROUND: This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. METHODS: The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. RESULTS: The modified Mayo wrist score in groups A, B, and C was 74.5 +/- 8.9, 73.9 +/- 11.6, and 61.3 +/- 10.2, respectively (p 0.05). CONCLUSIONS: Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.

Adult , Aged , Female , Humans , Male , Middle Aged , Arthroscopy , Debridement , Joint Diseases/surgery , Orthopedic Procedures/methods , Osteotomy , Triangular Fibrocartilage/surgery , Ulna/surgery , Wrist Joint/surgery
RBM rev. bras. med ; 67(supl.6)set. 2010.
Article in Portuguese | LILACS | ID: lil-558275


Foram submetidos ao tratamento em dois tempos cirúrgicos 17 pacientes com infecções crônicas em próteses de quadril e perda óssea circunferencial do fêmur proximal, consistindo da realização, no primeiro tempo, da retirada dos componentes e materiais infectados e colocação de espaçador de cimento com vancomicina e, no segundo tempo, da reconstrução do estoque ósseo com enxerto maciço da região proximal do fêmur e fixação da prótese através de hastes longas cimentadas ao enxerto e cimentas (dez hastes) ou não (sete hastes) no fêmur hospedeiro. Após nove anos de seguimento, em média (mínimo de sete anos), apenas um caso evoluiu com recidiva infecciosa. Todos os enxertos apresentaram sinais de consolidação radiográfica com o osso hospedeiro. Não houve solturas dos componentes femorais. Funcionalmente os pacientes melhoraram, embora a maioria deambule com marcha de Trendelemburg. O enxerto maciço de fêmur proximal se apresentou como uma técnica segura e reprodutível para o tratamento das falhas ósseas após artroplastia infectada de quadril.

Humans , Joint Diseases/surgery , Joint Diseases/pathology , Joint Diseases/therapy , Bone Transplantation/methods , Bone Transplantation/rehabilitation , Bone Transplantation
Rev. chil. reumatol ; 25(1): 42-48, 2009. ilus
Article in Spanish | LILACS | ID: lil-526891


El pinzamiento femoroacetabular es reconocido hoy como una de las principales causas de coxalgia en el adulto joven y corresponde a la primera causa de artrosis la cuarta y sexta década de la vida. El pinzamiento se produce debido a una incongruencia entre el acetábulo y la cabeza femoral; el origen de ésta puede ser principalmente de la porción femoral, tipo CAM, y/o de origen acetabular tipo PINCER. Es un fenómeno dinámico y progresivo en el tiempo, cuyo tratamiento es básicamente quirúrgico, a través de cirugía artroscópica, teniendo como objetivo la restitución de la anatomía normal de la cadera. Los resultados a mediano y largo plazo están en directa relación con el daño articular al momento de la cirugía, teniendo los mejores resultados en pacientes jóvenes y sin artrosis.

Hip impingement syndrome or femoro-acetabular impingement (F Al) is a well known cause of hip pain in the young-adult group, and it is also the main cause of arthritis among people in their forties to sixties. F Al is caused by an offset between the femoral head and acetabulum. This deformity may be mainly present on the femoral side: CAM type, and/or in the acetabular side: PINCER type. It is a dynamic and progressive concern that can be treated with arthroscopic surgery. The main goal of surgery is to restore the normal shape of the hip joint. Mid to long-term results for this procedure depend on age and joint status at the moment of the surgery. Younger, non arthritic patients respond better.

Humans , Adult , Acetabulum/surgery , Acetabulum , Joint Diseases/surgery , Joint Diseases , Osteoarthritis, Hip/surgery , Osteoarthritis, Hip , Arthroscopy , Hip Joint/surgery , Hip Joint , Joint Diseases/complications , Pain/etiology , Osteoarthritis, Hip/complications
Rev. chil. ortop. traumatol ; 47(2): 67-79, 2006. ilus
Article in Spanish | LILACS | ID: lil-559439


The hip can be a source of pain and physical impairment. Femoroacetabular impingement is one of many diagnoses. Femoroacetabular impingement has been associated to labral tears and early osteoarthritis. Treatment for this pathology may include surgery. The procedure will vary depending on the kind of impingement and concomitant lesions. The different surgical procedures have been described by non-arthroscopic approaches. As in other joints, the arthroscopic approach implies certain advantages, making it an attractive choice considering its lower frequency of complications. One of the limitations of arthroscopic procedures isthe technical difficulty it implies. Our group has performed 43 hip arthroscopic procedures for the treatment of femoroacetabular impingement with the technique described in this paper. Good to excellent results have been obtained in 91percent of the cases (39/43), in a short term follow up. In spite of the technical difficulties and complications proper of the procedure, the arthroscopic approach presents itself as a good alternative for the treatment of femoroacetabular impingement, allowing us to perform.

La articulación de la cadera puede ser origen de dolor y limitación funcional. Entre otros diagnósticos se encuentra el pellizcamiento femoroacetabular. El diagnóstico de pellizcamiento de cadera se ha visto asociado a rotura del labrum y artrosis precoz. El tratamiento de esta patología puede incluir cirugía. El procedimiento a realizar depende del tipo de pellizcamiento y lesiones asociadas. Los distintos procedimientos quirúrgicos han sido reportados por vía abierta. Al igual que en otras articulaciones, la vía artroscópica presenta ventajas relativas haciéndola una opción atractiva por su menor índice de complicaciones. Una de las limitantes de la artroscopía es la dificultad técnica que ésta plantea. Nuestro grupo ha realizado 43 artroscopías de cadera para el tratamiento del pellizcamiento femoroacetabular con la técnica aquí descrita. Se han obtenido buenos a excelentes resultados en 91por ciento de los casos (39/43), en un seguimiento a corto plazo. A pesar de las dificultades técnicas y complicaciones inherentes al procedimiento, la vía artroscópica se presenta como una buena alternativa de tratamiento de los pellizcamientos femoroacetabulares pudiendo hacerse desinserción del labrum, acetabuloplastia, re-inserción y bumpectomía.

Humans , Acetabulum/surgery , Acetabulum/injuries , Joint Diseases/surgery , Arthroscopy/methods , Femur/surgery , Femur/injuries
Medical Principles and Practice. 2005; 14 (4): 255-259
in English | IMEMR | ID: emr-73542


To present initial experience of the first 71 cases of cementless total hip replacement in Al Razi Hospital. Subject and Between 1996 and 2004, total hip replacement was performed in 71 patients [40 male, 31 female, average age 40.7 years, range 17-74] using Zweymiiller cementless prosthesis. The patients were followed clinically and radiologically over an average period of 36 months [range 6-84]. The results were assessed according to Merle d'Aubigne clinical score. Radiological assessment included position of the implant, behavior of the prosthesis/bone interface and signs of osteointegration. Average clinical score during the 3 years' follow-up period was 17.8 points. Most of the implants were in optimal positions. No significant radiological modifications of the implant-bone interface were observed. Zweymuller total hip prosthesis gives excellent clinical and radiological results in short-term follow-up

Humans , Female , Male , Hip Prosthesis , Joint Diseases/surgery , Postoperative Complications , Bone Cements , Follow-Up Studies , Osteoarthritis, Hip/surgery
An. méd. Asoc. Méd. Hosp. ABC ; 44(4): 159-62, oct.-dic. 1999. tab, ilus
Article in Spanish | LILACS | ID: lil-266887


Entre mayo de 1970 y mayo de 1975 se efectuaron 171 artroplastias de cadera. De éstas, 48 fueron en pacientes menores de 65 años. Diez enfermos murieron o fueron perdidos del seguimiento. Entre marzo y mayo de 1995, examinamos 30 pacientes con 42 artroplastias con un seguimiento mínimo de 20 años y máximo de 25 años (promedio de 21.5). Las edades fueron de 20 a 64 años (promedio 37.6 años). Veintiún procedimientos fueron en el lado derecho y 21 en el izquierdo. Diagnósticos: Dislocación congénita de cadera 13, osteoartritis 10, artritis reumatoides 10, espondilitis anquilosante 4, fracturas 3 y necrosis avascular 2. Resultados. Ausencia de dolor y movimientos normales en 28. Marcha normal en 26. Hodgkinson grado 0 en cuatro, grado I en 14, grado II en seis, grado III en dos y grado IV en 11. De acuerdo con Gruen, las zonas 1 y 7 fueron las más afectadas. Siguiendo a Pacheco: Aspecto normal en 17 casos, cavitación en nueve, demarcación en ocho, hundimiento en dos y fractura del cemento en uno. Los resultados fueron buenos reserva ósea. Los fracasos fueron más comunes en dislocaciones congénitas con múltiples procedimientos previos y errores técnicos

Humans , Adult , Middle Aged , Clinical Evolution , Joint Diseases/etiology , Joint Diseases/surgery , Hip Prosthesis/classification , Arthritis, Rheumatoid/surgery , Hip Joint/surgery , Hip Dislocation, Congenital/surgery , Osteonecrosis/surgery , Reoperation
Rev. mex. ortop. traumatol ; 11(6): 432-4, nov.-dic. 1997. tab
Article in Spanish | LILACS | ID: lil-227515


Se incluyeron en el presente estudio todos los pacientes que ingresaron al Servicio de Ortopedia del Hospital General de México, con patología de cadera propuestos para artroplastía total de cadera no cementada, en el periodo de enero de 1993 a julio de 1996, con un total de 42 pacientes con 46 artroplastías, con una edad mínima de 17años, máxima de 59 y promedio de 39.4 años. Las prótesis utilizadas fueron PCA (10), isoelásticas (12), Harris Galante (7), Osteonics (13), AML (2), Lima Litto (2). Se valoraron los pacientes a las 2, 6 y 12 semanas de postoperatorio utilizando la escala de Merle D'Aubigné. A las seis semanas marcha, 26 (61.90 por ciento) escala III, 16 (38.09 por ciento) en a escala IV. Dolor: 16 (38.09 por ciento) en la escala V, 26 (61.90 por ciento) en la escala VI. Movilidad: 42 (100 por ciento) en la escala III. A las 12 semanas, marcha: 28 (66.66 por ciento) escala V, 14 (33.33 por ciento) escala VI. Dolor 42 (100 por ciento) escala VI. Movilidad: 42 (100 por ciento) escala de III, y de acuerdo la satisfacción del paciente; regular 2 (4.76 por ciento), buena 21 (50 por ciento) y excelente 19 (45.23 por ciento). Se concluye que hasta la fecha, gran variedad de prótesis no cementadas han demostrado buena respuesta en un principio, mejorando notablemente la capacidad funcional del paciente

Humans , Male , Female , Adult , Postoperative Period , Disability Evaluation , Gait , Joint Diseases/surgery , Joint Diseases/physiopathology , Joint Diseases/rehabilitation , Pain Measurement , Hip Prosthesis
Rev. bras. ortop ; 32(11): 894-8, nov. 1997. ilus, tab
Article in Portuguese | LILACS | ID: lil-209280


Foram analisados 20 pacientes submetidos a carpectomia proximal do carpo. As seqüelas da pseudartrose do escafóide e necrose avascular do semilunar, acompanhadas sempre de artrose radiescafolunar, foram as indicaçoös em igual número de casos. A melhora significativa da dor, mobilidade e força e retorno à mesma atividade profissional foram observados em 90 por cento dos casos. A carpectomia proximal do carpo poderá ser considerada alternativa terapêutica para pacientes portadores de seqüelas traumáticas do carpo, com artrose radiescafolunar, em que será possível obter melhora funcional comparativamente ao estado pré-operatório.

Humans , Male , Female , Adult , Carpal Bones/surgery , Joint Diseases/surgery , Radius , Tarsal Bones , Carpal Bones , Pseudarthrosis , Pseudarthrosis/surgery
Rev. mex. ortop. traumatol ; 11(5): 327-31, sept.-oct. 1997.
Article in Spanish | LILACS | ID: lil-227168


Los tres principales retos que se plantean en la reconstrucción de una Seudoartrosis Congénita de Tibia (SCT) son: 1) lograr la unión ósea, 2) Corregir la discrepancia de longitud y 3) Minimizar la hiportrofia de la extremidad. Presentamos una serie de 5 pacientes con diagnóstico de SCT tipo II de Boyd, intervenidos entre los 18 meses y los 7 años meses (m;4a 2m) 4 pacientes con un total de 9 cirugías previas y uno solo sin antecedentes quirúrgicos. El acortamiento previo varió entre 3 y 7 cm. A todos los pacientes se les transfirió un peroné vascularizado con una longitud entre 8.7 y 14 cm, utilizando fijación externa en 3 y clavo centromedular en 2 casos. En todos los casos se obtuvo consolidación ósea: la unión proximal entre las 6 y 24 semanas y la distal entre las 6 y 16 semanas. En cuatro pacientes se retiró la osteosíntesis y se inició el apoyo gradual a partir de las 16 semanas. Se dio el índice de hipertrofia del peroné transplantado según de Boer y Wood, encontrando hipertrofia mayor del 20 por ciento a partir de la 4ª semana e hipertrofia endóstica entre la 8ª y 10ª semanas. Las complicaciones fueron: neuropraxia bilateral del sural externo que revirtió rápidamente (un caso), contractura del flexor hallucis longus manejada con servadoramante (un caso), infección del tracto de los clavos en un fijador que requirió de su retiro precozmente (un caso) y consolidación en valgo de tobillo que requirió de osteotomía correctora (un caso), El acortamiento residual al máximo seguimiento fue de entre 0 a 2.5 cm. La transferencia microvascular de peroné es el método más efectivo en el manejo actual de SCT tipo II de Boyd o multioperadas. Su morbilidad es menor que la reportada para otros métodos convencionales más reconocidos

Humans , Female , Infant , Tibia/abnormalities , Joint Diseases/surgery , Joint Diseases/congenital , Fibula/transplantation