RESUMO
Cobalt-induced cardiomyopathy is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. We report two patients with cobalt-induced cardiomyopathy. Both patients developed progressively worsening symptoms of cobalt toxicity following revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. In both patients, echocardiography showed LV hypertrophy, biventricular systolic dysfunction, and a large amount of pericardial effusion. Due to decompensated heart failure, both patients were initially considered candidates for heart transplantation. One patient was diagnosed with cobalt-induced cardiomyopathy before transplantation. He received cobalt chelation therapy and revision surgery, which led to complete recovery of heart function. In the other patient, the diagnosis was not made until the time of heart transplantation. The gross examination of the explanted heart revealed typical features of cobalt cardiotoxicity, which was then diagnosed as cobalt-induced cardiomyopathy. These cases emphasise the importance of early diagnosis and prompt treatment of cobalt intoxication.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cardiomiopatias/induzido quimicamente , Cobalto/efeitos adversos , Insuficiência Cardíaca/induzido quimicamente , Prótese de Quadril/efeitos adversos , Disfunção Ventricular Esquerda/induzido quimicamente , Biópsia , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Cardiotoxicidade , Quelantes/uso terapêutico , Progressão da Doença , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Transplante de Coração , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recuperação de Função Fisiológica , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapiaRESUMO
The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Tromboembolia Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Razão de Chances , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/epidemiologiaRESUMO
PURPOSE: In an alumina-on-alumina total hip arthroplasty (THA), recommended with a small inclination angle <45°, the acetabular component (cup) may be positioned more medially to be covered almost completely by host bone. The purpose of this study was to identify the correlating factors and to evaluate the outcomes of medial placement of the cup in patients with alumina-on-alumina THAs. METHODS: Using the propensity score matching with age, gender, body mass index, initial diagnosis, and the length of follow-up as variables, 38 hips with a medialized cup and 38 hips with a non-medialized one were identified from 389 hips in 347 who patients underwent primary alumina-on-alumina THA and followed up for more than 7 years. Clinical and radiological outcomes were compared between the two groups. RESULTS: Preoperative acetabular medial wall thickness and the cup inclination angle were significantly smaller in the medialization group compared to the non-medialization group. Center edge angle, cup size, and coverage by host bone were not significantly different between the two groups. The hip center of rotation was significantly medialized in the medialization group. The Harris hip scores were not significantly different between the two groups. No component loosening or osteolysis was observed and no revision was required in either groups. CONCLUSIONS: Thin acetabular medial wall and a small inclination angle of the cup were the correlating factors of medial placement of the cup in patients who underwent an alumina-on-alumina THA. Medial placement did not lead to differences in the clinical or radiological outcomes.
Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Próteses Articulares Metal-Metal , Osteoartrite do Quadril/cirurgia , Adolescente , Adulto , Idoso , Óxido de Alumínio , Artroplastia de Quadril/instrumentação , Materiais Biocompatíveis , Feminino , Articulação do Quadril , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Desenho de Prótese , Adulto JovemRESUMO
We evaluated the outcomes of 64 consecutive revision total hip arthroplasties with an alumina-on-alumina bearing surface in 61 patients with osteolysis. No implants had been rerevised nor was osteolysis detected at a mean of 9.8 years (range, 7.0-13.1 years) postoperatively. There was 1 case of stem loosening but no cup loosening or alumina bearing fractures. Two surgical procedures were performed for an infection in 1 patient. Three dislocations occurred in 3 hips; all were treated with closed reduction and abduction bracing for 3 months. No further dislocations occurred. With any reoperation or radiographic evidence of osteolysis or loosening as the end point, the 7-year survival rate was 96.9% (95% confidence interval, 90.8%-100%). The alumina-on-alumina bearing surfaces used for revision total hip arthroplasty in patients with osteolysis were found to produce encouraging clinical results and implant survival rates at a minimum of 7 years postoperatively.
Assuntos
Óxido de Alumínio , Artroplastia de Quadril , Prótese de Quadril , Osteólise/cirurgia , Adulto , Idoso , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Radiografia , Reoperação , Adulto JovemRESUMO
Although the incidence of malignant tumors in patients undergoing total hip arthroplasties (THAs) is known to be lower than the general population, there exist several reports on the development of malignant tumors at the site of THAs. We report another case of malignant fibrous histiocytoma at the site of a THA, which was developed in an older patient who presented a cystic mass around the total hip prosthesis using a ceramic-on-ceramic bearing system, even without evidence of osteolysis or loosening of implants. This is the second case associated with an aluminum oxide prosthesis in English literature.