ABSTRACT
To establish the pattern of bone remodeling caused by a cementless, anatomic implant, we intend to evaluate the changes in bone mineral density observed after surgery in the Gruen zones. A controlled, prospective study was carried out, in which a group of 37 patients with primary coxarthrosis were densitrometrically analyzed over the 1 year period following the implant of an ANATO stem (Stryker). The patient's healthy hip was taken as the control. Any differences in the remodeling pattern were compared according to age, body mass index, and implant size. Decreases in bone mineral density were observed after 3 months in all of the zones studied. However, this bone mineral density loss was recovered in all zones by the end of the study, except in zone 7 where a decrease of 7.2% in bone mass was observed. In zones 2 and 6, where more loads are transmitted, bone mass preservation, in accordance with Wolff's law, can be seen. No differences were found in the remodeling pattern in relation to age and body mass index. There were also no differences related to stem size except in zones 1 and 7. The ANATO stem achieves an efficient transmission of loads between the stem and the proximal femur, providing enough mechanical loads for bone preservation. It is only in zone 7 where significant bone atrophy can be observed, attributable to the damage that this area suffers during the surgical process and the subsequent stress-shielding caused by the implant design.
Subject(s)
Arthroplasty, Replacement, Hip , Bone Density , Bone Remodeling , Femur/diagnostic imaging , Hip Prosthesis , Osteoarthritis, Hip/surgery , Weight-Bearing , Adult , Aged , Atrophy , Biomechanical Phenomena , Female , Femur/pathology , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis DesignABSTRACT
INTRODUCTION: giant cell is a tumor that appears in young adults, requirirng surgical treatment due to its metastatic capacity, but recurrence rates makes no consensus about theraperutic management. METHODS: 23 patients were operated between 1996-2012 at Miguel Servet hospital, performing a mean of 8.9 years follow-up. RESULTS: Functional result was satisfactory in all cases, being able to perform normal phisical activity. Six recurrences were detected, which required surgical treatment, showing complete recovery at the end of the follow-up. One patient died by pulmonary metastasis. CONCLUSION: Surgery is the most appropriate treatment in giant cell tumors, having shown good results both in treatment of primary tumor and recurrences.
Subject(s)
Giant Cell Tumor of Bone/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Neoplasm Recurrence, Local/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: On the anterior thoracic wall, some supernumerary muscular masses can be present, like the sternalis muscle, which is situated over the pectoralis major muscle fascia, deep to the subcutaneous tissue. Its fibers can be parallel or oblique to the sternum, and are clinically important due to the possibility that during certain radiologic procedures they can be confused with some types of breast pathologies. MATERIAL AND METHODS: Bibliographic review of supernumerary muscular masses of the anterior thoracic wall and case report in a colombian male cadaver of mixed ethnia, dissected by medical students at the Department of Morphology at the Universidad del Valle, in Cali, Colombia. RESULTS: In the right side of the anterior thoracic wall of the cadaver an anatomical variation of low occurrence in the general population, the sternalis muscle, was found. The muscle fibers had a vertical direction, parallel to the right sternal margin. Considering all the muscular fascicles, its dimensions were approximately 7,0 cms in length and 2,9cms in width. CONCLUSION: Having in mind the characteristics of the present anatomical variation, and that there can be some radiologic, surgical and clinical implications, it is important for the health professional to know the anatomy and epidemiology of the sternalis muscle.
Subject(s)
Pectoralis Muscles/abnormalities , Thoracic Wall/abnormalities , Cadaver , Costal Cartilage/abnormalities , Humans , Male , Middle AgedABSTRACT
Introducción: el tumor de células gigantes se presenta en adultos jóvenes, y su capacidad metastásica obliga a realizar un tratamiento quirúrgico, aunque su tasa de recurrencias hace que no haya consenso respecto a la conducta terapéutica. Método: 23 pacientes fueron intervenidos en el periodo de 1996 a 2012 en el hospital universitario Miguel Servet, a los que se les realizó un seguimiento medio de 8,9 años. Resultados: el resultado funcional fue satisfactorio en todos los casos, pues todos los pacientes pudieron reanudar su actividad física habitual. Se detectaron 6 pacientes con recurrencias que fueron tratadas quirúrgicamente; estos pacientes también tuvieron una recuperación total. Un paciente falleció a causa de metástasis pulmonares. Conclusiones: el tratamiento quirúrgico es el más indicado en tumores de células gigantes, se lograron buenos resultados tanto en el tratamiento del tumor primario como de las recidivas(AU)
Introduction: giant cell tumor occurs in young adults, and their metastatic capacity requires a surgical treatment, although the recurrence rate makes no consensus on the therapeutic approach. Method: twenty-three patients were operated from 1996 to 2012 at Miguel Servet University Hospital; they underwent an 8.9 year-mean follow up. Results: the functional result was satisfactory in all cases, for all patients were able to return their usual physical activity. Six patients with recurrences were surgically treated; these patients also had a full recovery. One patient died of pulmonary metastases. Conclusions: surgical treatment is the most suitable approach in giant cell tumors, good results were achieved both in the treatment of primary tumor as well as of recurrence(AU)
Introduction: La tumeur à cellules géantes se rencontre chez des jeunes adultes, et sa capacité de métastase impose un traitement chirurgical, quoique son taux de récurrence empêche qu'il n'y ait pas de consensus sur la conduite thérapeutique à suivre. Méthodes: Dans la période 1996-2012, vingt-trois patients ont été traités chirurgicalement à l'hôpital universitaire Miguel Servet, et ils ont été suivis pendant une période moyenne de 8,9 ans. Résultats: Il y a eu des résultats satisfaisants en ce qui concerne la fonction, parce que tous les patients ont pu reprendre leurs activités quotidiennes. Dans quelques cas (6 patients), on a détecté des récurrences qui ont été traitées chirurgicalement. La récupération de ces patients a été totale, mais un patient est décédé à cause d'une métastase pulmonaire. Conclusions: Le traitement chirurgical est la conduite la plus appropriée dans les cas de tumeur à cellules géantes. On a obtenu de bons résultats dans le traitement de la tumeur primaire et des récidives(AU)