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1.
Zhonghua Wai Ke Za Zhi ; 58(6): 416-419, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498478

RESUMO

Bearing dislocation is a special complication of mobile-bearing unicompartmental arthroplasty, caused by many factors, such as imbalance of the flexion and extension gap, malposition of components, impingement by the remaining osteophytes and cement, damage or delayed chronic laxity of medial collateral ligament, traumatic accident and habitual high knee flexion. It can be reduced by strictly controlling the operation indications before operation, osteotomy and implanting the prosthesis accurately while protecting the medial collateral ligament during operation, actively guiding the appropriate rehabilitation actions and activity intensity of patients after operation. Treatment should be individualized according to the causes and individual conditions of patients.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artropatias/cirurgia , Prótese do Joelho/efeitos adversos , Falha de Prótese , Artroplastia do Joelho/instrumentação , Humanos , Artropatias/etiologia , Artropatias/prevenção & controle , Articulação do Joelho/cirurgia , Desenho de Prótese , Falha de Prótese/etiologia
2.
Zhonghua Wai Ke Za Zhi ; 58(6): 435-440, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498482

RESUMO

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.


Assuntos
Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Adulto , Feminino , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Tíbia/cirurgia , Anormalidade Torcional/etiologia , Adulto Jovem
3.
Orthop Clin North Am ; 51(3): 383-389, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498957

RESUMO

Traditionally, total shoulder arthroplasty is performed through the deltopectoral approach with violation of the subscapularis tendon. In order to reduce the incidence of postoperative subscapularis dysfunction, the subscapularis-sparing approach, performed entirely through the rotator interval, was developed. This technique allows earlier rehabilitation and may potentially prevent subsequent subscapularis insufficiency and clinical failures.


Assuntos
Artroplastia do Ombro/métodos , Artropatias/cirurgia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/reabilitação , Humanos , Artropatias/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem
4.
N Z Med J ; 133(1515): 70-78, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438378

RESUMO

AIMS: To describe health conditions in New Zealand nuclear veterans and their offspring, and examine the utility of tests to assess their heritability. METHOD: An online survey, open to all veterans and offspring, with questions on health conditions, the GHQ12 to measure psychological distress, the Euroquol-5D visual analogue scale (EQ5D VAS) to measure health state, and free text items on veteran support. RESULTS: Eighty-three responses (56%) were from veterans, 65 (44%) from offspring. Anxiety and depression were prevalent in both groups, with cancers (n=31, 37%) and joint conditions common in veterans (n=26, 31%). Few offspring reported cancer, rather problems with fertility (n=18, 40%). The free text themes fell into four domains, official commitment, health, emotional and information support; however, little support had been sought. CONCLUSION: Cancers have utility in assessing heritability, but a low prevalence and lack of diagnostic data rules this out. Psychological conditions may be heritable, but the techniques to assess this are still developing. Chromosomal damage in veterans and offspring can be detected, but with present knowledge cannot explain health outcomes. Future work should assemble a veteran and family register with linkage to routine data-sets. Veterans and offspring should be encouraged to seek support.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Neoplasias/epidemiologia , Armas Nucleares , Exposição Ocupacional , Veteranos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Ansiedade/genética , Depressão/genética , Família , Testes Genéticos , Inquéritos Epidemiológicos , Humanos , Infertilidade/epidemiologia , Infertilidade/genética , Artropatias/epidemiologia , Artropatias/genética , Pessoa de Meia-Idade , Neoplasias/genética , Nova Zelândia/epidemiologia , Exposição Ocupacional/efeitos adversos , Prevalência , Radiação Ionizante , Apoio Social , Adulto Jovem
5.
PLoS Pathog ; 16(5): e1008516, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32413091

RESUMO

Lyme disease, caused by Borrelia burgdorferi, B. afzelii and B. garinii, is a chronic, multi-systemic infection and the spectrum of tissues affected can vary with the Lyme disease strain. For example, whereas B. garinii infection is associated with neurologic manifestations, B. burgdorferi infection is associated with arthritis. The basis for tissue tropism is poorly understood, but has been long hypothesized to involve strain-specific interactions with host components in the target tissue. OspC (outer surface protein C) is a highly variable outer surface protein required for infectivity, and sequence differences in OspC are associated with variation in tissue invasiveness, but whether OspC directly influences tropism is unknown. We found that OspC binds to the extracellular matrix (ECM) components fibronectin and/or dermatan sulfate in an OspC variant-dependent manner. Murine infection by isogenic B. burgdorferi strains differing only in their ospC coding region revealed that two OspC variants capable of binding dermatan sulfate promoted colonization of all tissues tested, including joints. However, an isogenic strain producing OspC from B. garinii strain PBr, which binds fibronectin but not dermatan sulfate, colonized the skin, heart and bladder, but not joints. Moreover, a strain producing an OspC altered to recognize neither fibronectin nor dermatan sulfate displayed dramatically reduced levels of tissue colonization that were indistinguishable from a strain entirely deficient in OspC. Finally, intravital microscopy revealed that this OspC mutant, in contrast to a strain producing wild type OspC, was defective in promoting joint invasion by B. burgdorferi in living mice. We conclude that OspC functions as an ECM-binding adhesin that is required for joint invasion, and that variation in OspC sequence contributes to strain-specific differences in tissue tropism displayed among Lyme disease spirochetes.


Assuntos
Borrelia burgdorferi/metabolismo , Dermatan Sulfato/metabolismo , Matriz Extracelular/metabolismo , Artropatias/metabolismo , Articulações/metabolismo , Doença de Lyme/metabolismo , Animais , Antígenos de Bactérias , Aderência Bacteriana , Proteínas da Membrana Bacteriana Externa , Borrelia burgdorferi/genética , Borrelia burgdorferi/patogenicidade , Dermatan Sulfato/genética , Matriz Extracelular/genética , Matriz Extracelular/microbiologia , Matriz Extracelular/patologia , Feminino , Fibronectinas/genética , Fibronectinas/metabolismo , Artropatias/genética , Artropatias/microbiologia , Artropatias/patologia , Articulações/microbiologia , Articulações/patologia , Doença de Lyme/genética , Doença de Lyme/microbiologia , Doença de Lyme/patologia , Camundongos , Camundongos SCID , Mutação , Especificidade de Órgãos
6.
Medicine (Baltimore) ; 99(15): e19806, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282746

RESUMO

RATIONALE: Acute lymphoblastic leukemia (ALL) has acute and severe onset characterized by fever, moderate to severe anemia, bone and joint pain, and sternal tenderness. It is easy to be misdiagnosed as rheumatic disease when joint pain is the first symptom. PATIENT CONCERNS: A male Han, 18 years of age was admitted on July 15th, 2016 for multi-joint swelling and pain with intermittent fever for half a year which had aggravated in the last 10 days. DIAGNOSIS: Based on symptoms, imaging, family history, and blood tests, he was first diagnosed with ankylosing spondylitis, but he was refractory to treatment. Bone marrow biopsy then revealed acute B-lymphoblastic leukemia (possibility Pro-B-ALL). INTERVENTIONS: The patient was transferred to the hematology department on July 23rd, 2016 for chemotherapy. OUTCOMES: No joint pain occurred during follow-up, which ended on November 4th, 2018. LESSONS: ALL may present with symptoms suggestive of rheumatic diseases like ankylosing spondylitis. Physicians should be aware of this possibility, especially in young patients.


Assuntos
Artralgia/etiologia , Leucemia Linfocítica Crônica de Células B/patologia , Espondilite Anquilosante/diagnóstico , Adolescente , Antineoplásicos/uso terapêutico , Artralgia/diagnóstico , Biópsia , Medula Óssea/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Febre/diagnóstico , Febre/etiologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/patologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Masculino , Espondilite Anquilosante/sangue , Espondilite Anquilosante/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
FP Essent ; 491: 27-32, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32315146

RESUMO

The clavicle is the most commonly fractured bone, and the most frequently fractured part of the clavicle is the middle third (ie, midshaft). X-ray usually is the first-line imaging modality for clavicle injuries. Conservative management is preferred for patients with uncomplicated and nondisplaced clavicular fractures. Typically, immobilization should last 4 weeks, then range-of-motion exercises should begin after 4 weeks, with full return to activities by 12 weeks. Distal clavicle osteolysis is a relatively uncommon pathologic bone resorption that occurs with repetitive overhead activities. Conservative management includes activity modification, nonsteroidal anti-inflammatory drugs, and injection. Surgical options also are available. Acute acromioclavicular (AC) joint injuries usually are the result of a direct blow to the superolateral shoulder with the humerus in adduction. The Rockwood classification system of AC joint injuries describes types I to VI, classified by the ligaments injured and degree of displacement. Low-grade AC joint injuries (ie, types I to III) typically can be managed nonsurgically, whereas high-grade injuries are managed with surgery. Osteoarthrosis of the AC joint manifests similarly to distal clavicle osteolysis and may be posttraumatic or idiopathic. Osteoarthrosis typically is managed with activity modification, nonsteroidal anti-inflammatory drugs, and injections but also may be managed surgically.


Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Artropatias , Articulação Acromioclavicular/diagnóstico por imagem , Clavícula , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/terapia , Ombro
8.
Zhongguo Gu Shang ; 33(3): 283-7, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233262

RESUMO

Heterotopic ossification is the formation of pathological bone in non-skeletal tissues (including muscles, tendons or other soft tissues), and the pathogenesis is not completely clear. It is often caused by musculoskeletal trauma, postoperative bone and joint surgery, or damage of the nervous system, the clinical manifestations are joint swelling, pain, and movement disorders, which often occur around the hips, knees, and elbows. At present, the prevention of heterotopic ossification mainly includes drugs, radiotherapy, molecular biological mechanism intervention, and Chinese medicine-related measures. Among them, drugs and radiotherapy are more effective methods to prevent heterotopic ossification. The intervention of molecular biology mechanism to prevent heterotopic ossification has become a new research direction and focus of attention inrecent years, and is basically at the experimental research stage. The treatment of heterotopic ossification includes various methods such as drugs, physical therapy, and surgery. Among them, surgery is recognized as the most effective treatment, however there are still some controversies and disagreements about the choice of operation time and surgical methods.


Assuntos
Articulação do Cotovelo , Artropatias , Ossificação Heterotópica , Cotovelo , Humanos , Ossificação Heterotópica/prevenção & controle , Ossificação Heterotópica/terapia , Resultado do Tratamento
9.
Phys Ther ; 100(6): 917-932, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32128572

RESUMO

BACKGROUND: Physical therapy and surgery are viable treatment options for nonarthritic hip disease (NAHD). Interdisciplinary collaboration can help patients make informed treatment decisions. Understanding how each provider can contribute is a critical first step in developing collaborative evaluation efforts. OBJECTIVE: The objective of this study was to describe the current evaluation of NAHD by both physical therapists and physicians, and evaluate national use of expert-recommended evaluation guidelines. DESIGN: A national survey study distributed in the United States was implemented to accomplish the objective. METHODS: A survey was distributed to 25,027 potential physical therapist and physician respondents. Respondents detailed their evaluation content for patients with NAHD across the following domains: patient-reported outcomes, patient history, special tests, movement assessment, clinical tests, and imaging. Respondents ranked importance of each domain using a 5-point Likert scale (not important, slightly important, important, very important, or extremely important). Odds ratios (ORs [95% CIs]) were calculated to identify the odds that physical therapists, compared with physicians, would report each evaluation domain as at least very important. Fisher exact tests were performed to identify statistically significant ORs. RESULTS: Nine hundred and fourteen participants (3.6%) completed the survey. Physical therapists were more likely to indicate movement assessment (OR: 4.23 [2.99-6.02]) and patient-reported outcomes (OR: 2.56 [1.67-3.99]) as at least very important for determining a diagnosis and plan of care. Physical therapists had lower odds of rating imaging (OR: 0.09 [0.06-0.14]) and special tests (OR: 0.72 [0.53-0.98]) as at least very important compared with physicians. LIMITATIONS: This survey study did not include many orthopedic surgeons and thus, primarily represents evaluation practices of physical therapists and nonsurgical physicians. CONCLUSIONS: Physical therapists were more likely to consider movement assessment very important for the evaluation of patients with NAHD, whereas physicians were more likely to consider imaging and special testing very important.


Assuntos
Articulação do Quadril , Artropatias/diagnóstico , Ortopedia , Fisioterapeutas , Medicina Esportiva , Competência Clínica , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Articulação do Quadril/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Anamnese , Movimento , Razão de Chances , Ortopedia/educação , Ortopedia/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Exame Físico/métodos , Fisioterapeutas/educação , Fisioterapeutas/estatística & dados numéricos , Projetos Piloto , Medicina Esportiva/educação , Medicina Esportiva/estatística & dados numéricos , Estados Unidos
10.
Clin Orthop Surg ; 12(1): 94-99, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117544

RESUMO

Background: There is a paucity of literature on the use of hip arthroscopy for pathologic conditions in skeletally immature patients. Thus, the indications and safety of the procedure are still unclear. The purpose of this study was to investigate the safety and functional outcomes of hip arthroscopy for pediatric and adolescent hip disorders. We further attempted to characterize arthroscopic findings in each disease. Methods: We retrospectively reviewed 32 children and adolescents with hip disorders who underwent 34 hip arthroscopic procedures at a tertiary care children's hospital from January 2010 to December 2016. We evaluated functional limitations and improvement after operation by using the modified Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective pain assessment with a visual analog scale (VAS), and range of hip motion as well as the complications of hip arthroscopy. Arthroscopic findings in each disease were recorded. Results: Hip arthroscopy was performed for Legg-Calvé-Perthes disease (n = 6), developmental dysplasia of the hip (n = 6), slipped capital femoral epiphysis (n = 5), idiopathic femoroacetabular impingement (n = 6), sequelae of septic arthritis of the hip (n = 3), hereditary multiple exostosis (n = 2), synovial giant cell tumor (n = 3), idiopathic chondrolysis (n = 2), and posttraumatic osteonecrosis of the femoral head (n = 1). Overall, there was a significant improvement in the modified HHS, WOMAC, VAS, and range of hip motion. Symptom improvement was not observed for more than 18 months in four patients who had dysplastic acetabulum with a labral tear (n = 2) or a recurrent femoral head bump (n = 2). There were no complications except transient perineal numbness in five patients. Conclusions: Our short-term follow-up evaluation shows that hip arthroscopy for pediatric and adolescent hip disorder is a less invasive and safe procedure. It appears to be effective in improving functional impairment caused by femoroacetabular impingement between the deformed femoral head and acetabulum or intra-articular focal problems in pediatric and adolescent hip disorders.


Assuntos
Artroscopia , Articulação do Quadril/cirurgia , Artropatias/cirurgia , Adolescente , Criança , Avaliação da Deficiência , Feminino , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
11.
Int J Infect Dis ; 93: 126-132, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32007642

RESUMO

OBJECTIVES: This study evaluated the incidence, risk factors, and clinical characteristics of complications of candidaemia in adults, with a focus on endophthalmitis, endocarditis, and osteoarticular infections. METHODS: All patients ≥18 years old with candidaemia in two Korean tertiary hospitals from 2007 to 2016 were investigated. Complications of candidaemia were defined as the presence of endophthalmitis, endocarditis, or osteoarticular infections documented in patients with candidaemia. The clinical characteristics and risk factors for candidaemia with complications were analysed in the patients who underwent ophthalmological examinations. RESULTS: Of 765 adult patients with candidaemia, 34 (4.4%) met the definition of complications, including endophthalmitis in 29 (3.8%), endocarditis in 4 (0.5%), and osteoarticular infections in 3 (0.4%). Of the 225 patients who underwent ophthalmological examinations, 29 (12.9%) had endophthalmitis. Candida albicans was an independent risk factor for complicated candidaemia (OR, 5.12; 95% CI, 2.17-12.09; P < 0.001). Although the mortality rate was no higher in complicated candidaemia, the duration of antifungal therapy was longer (23.1 ± 17.6 vs. 16.4 ± 10.8 days, P = 0.042), and 13 patients (39.3%) underwent additional procedures or surgery. CONCLUSIONS: Complications of candidaemia occurred in 4.4% of adult patients. C. albicans was an independent risk factor for complicated candidaemia in adults. Complications of candidaemia might need prolonged treatment and additional procedures or surgery. Therefore, careful evaluation and active treatment of candidaemia with complications should be encouraged.


Assuntos
Candidemia/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Doenças Ósseas Infecciosas/epidemiologia , Doenças Ósseas Infecciosas/microbiologia , Candida albicans , Candidemia/diagnóstico , Candidemia/tratamento farmacológico , Candidemia/microbiologia , Endocardite/epidemiologia , Endocardite/microbiologia , Endoftalmite/epidemiologia , Endoftalmite/microbiologia , Feminino , Humanos , Incidência , Artropatias/epidemiologia , Artropatias/microbiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Radiol Med ; 125(7): 605-608, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32026189

RESUMO

There is wide variation in the technique and type of contrast used for MR arthrography of shoulder. In this article, we discuss the current practice in UK and the reason for the change over the last few years.


Assuntos
Meios de Contraste/administração & dosagem , Artropatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Padrões de Prática Médica/estatística & dados numéricos , Articulação do Ombro/diagnóstico por imagem , Meios de Contraste/provisão & distribução , Gadolínio , Humanos , Reino Unido
13.
J Shoulder Elbow Surg ; 29(2): 340-346, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31952560

RESUMO

BACKGROUND: Post-traumatic elbow arthrofibrosis (PEA) and its associated limitations to elbow range of motion (ROM) are a recognized consequence of trauma to the pediatric elbow. Closed manipulation under anesthesia (CMUA) of the elbow can be performed in pediatric patients as a nonoperative attempt to improve dysfunctional ROM. Minimal outcome data to support CMUA exist. The study evaluates the efficacy of CMUA for PEA in pediatric patients. METHODS: Patients younger than 18 years who underwent CMUA (Current Procedural Terminology code 24300) for PEA between 2005 and 2015 at 3 institutions were included. A retrospective chart review was performed to collect demographic data and ROM premanipulation and at last follow-up. Paired 2-tailed t tests were used to compare pre- and postmanipulation elbow ROM. RESULTS: Thirteen patients with a mean age of 12.2 ± 2.6 years (range 6.7-15.6 years) met the inclusion criteria. Median time to CMUA from initial surgery was 4.2 months (interquartile range [IQR] 3.6-8.4, range 1.4-19.7 months). Median follow-up time was 6 months with an IQR of 3.3-10.0 months. At last follow-up, there was significant improvement in elbow flexion of 22° ± 17° (P < .001) and extension of 29° ± 21° (P < .001). The average premanipulation motion arc of 60° ± 24° significantly increased to 110° ± 22° at final assessment (P < .001). CONCLUSION: CMUA appears to be a valuable alternative and reliable procedure for improving PEA in pediatric patients who exhaust nonoperative interventions.


Assuntos
Articulação do Cotovelo/lesões , Fibrose/cirurgia , Artropatias/cirurgia , Adolescente , Anestesia , Criança , Estudos de Coortes , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Manipulação Ortopédica , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
14.
J Pediatr Orthop ; 40(2): 97-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923170

RESUMO

BACKGROUND: Pediatric osteoarticular infection can cause severe morbidity. Some infectious loci may be difficult to identify clinically, and there may be more than one. There is little agreement regarding the appropriate use of preoperative magnetic resonance imaging (MRI) in this setting. After noting an unacceptably high rate of unplanned returns to the operating room for recurrent infection, clinicians at a tertiary care children's hospital noticed many patients had adjacent foci of infection on postoperative MRI. As a result, patients experienced prolonged treatment courses and multiple surgeries. An interdisciplinary team instituted practice guidelines whereby all patients with suspected osteoarticular infection underwent MRI for planned debridement during a reserved morning slot with a surgical suite on hold to proceed directly to surgery if indicated. Images were reviewed in real time to form the surgical plan. Young patients that required sedation for MRI were taken to surgery under the same anesthetic used for MRI without being awakened. The purpose of our retrospective study is to determine if implementing the practice guidelines for acute management of osteoarticular infection reduced unplanned returns to the operating room. METHODS: A total of 93 patients with osteoarticular infection were included in this study. A total of 40 cases, group A, were treated before implementing practice guidelines; 53 cases, group B, were treated after implementing practice guidelines. Our primary outcomes of interest were the identification of adjacent infections prior to surgery and need for repeat surgery, either planned or unplanned. RESULTS: Implementation of these guidelines reduced repeat surgery from 50% of patients to <27% (P=0.0099). Of patients requiring repeat surgery, 85% (n=17) were unplanned in group A versus 60% (n=9) in group B (P=0.0099). Adjacent infections were identified in 47.5% (n=19) of patients in group A, versus 60% (n=32) in group B. Adjacent infections were known before surgery in 32% (n=6) of patients in group A versus 72% (n=23) in group B. There were no statistically significant differences in initial patient characteristics or sites of infection. CONCLUSIONS: Implementing these guidelines reduced the need for repeat surgery in this population. It is difficult to predict with sufficient accuracy which patients need preoperative MRI. While resource intensive, preoperative MRI appears to offer substantial benefit in preoperative planning.


Assuntos
Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Imagem por Ressonância Magnética , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Reoperação , Adolescente , Criança , Pré-Escolar , Desbridamento , Humanos , Lactente , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Estudos Retrospectivos
15.
World Neurosurg ; 134: 201-210, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31655232

RESUMO

Facet joint osteoarthritis/arthropathy of the spine is a common cause of back and neck pain that frequently overlaps clinically with other diseases of the spine. Because of the possible overlap, it is crucial to have an accurate diagnostic strategy, especially when determining the management approach. Various strategies have been suggested and adopted, with several these still being used in clinics. Over the years, because of the disadvantages of single-modality imaging methods (computed tomography, magnetic resonance imaging, single-photon emission computed tomography), the interest in radiologic examination started to move toward hybrid imaging techniques. Although the data are mixed, many initial studies have shown promise. However, there are relatively few data with comparative medial branch blocks, and further investigation is needed. Given the advantages and disadvantages of these new techniques, the imaging results have to be interpreted within clinical context and with consideration of the current state of knowledge in the decision-making process.


Assuntos
Imagem Multimodal/métodos , Osteoartrite/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
16.
Arch Orthop Trauma Surg ; 140(1): 129-137, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31696320

RESUMO

INTRODUCTION: While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS: We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS: Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS: The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.


Assuntos
Acetábulo , Artroplastia de Quadril/métodos , Cabeça do Fêmur , Articulação do Quadril , Artropatias , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Estudos de Coortes , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Artropatias/classificação , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Cuidados Pré-Operatórios , Radiografia , Tomografia Computadorizada por Raios X
17.
Orthopade ; 49(3): 267-272, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31811322

RESUMO

The combination of glenoid destruction with cuff arthropathy remains a challenge. A 75-year old woman presented with a post-traumatic loss of the glenoid and concomitant cuff arthropathy. Using CT-data a custom-made glenoid component was created by 3D printing. 6 months after reverse shoulder arthroplasty, the patient was free of pain with acceptable ROM. An individual glenoid component created by 3D printing is a feasible therapeutic option in patients with loss of the glenoid and concomitant cuff arthropathy.


Assuntos
Artropatias , Prótese Articular , Impressão Tridimensional , Articulação do Ombro , Idoso , Artroplastia , Feminino , Humanos , Lesões do Manguito Rotador , Escápula
18.
Vet Surg ; 49(1): 155-159, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31322757

RESUMO

OBJECTIVE: To determine the predictive value of meniscal click for specific meniscal tear morphology. STUDY DESIGN: Prospective cohort. ANIMALS: Client-owned dogs (104) with cranial cruciate ligament (CCL) deficiency treated with stifle arthroscopy (111). METHODS: All stifles underwent a standardized examination for meniscal click before anesthesia (EBA) and during anesthesia (EDA). Presence or absence of a medial meniscal tear and diagnosis of tear morphology were confirmed with arthroscopic examination. RESULTS: Complete CCL tears were noted in 93 dogs, and incompetent partial tears were noted in 18 dogs. Medial meniscal tears were noted in 40.5% (55/111) of dogs, including bucket handle tears (BHT) in 65.6% (36/55) of tears. Frays of the lateral meniscus were noted in 6.3% of dogs (7/111). Examination for meniscal click before anesthesia was 38% sensitive and 94.5% specific, and EDA was 38% sensitive and 98.2% specific for all meniscal tear morphologies. Positive meniscal click at EBA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .3515, respectively). Positive meniscal click at EDA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .1909, respectively). CONCLUSION: A meniscal click is more commonly associated with a meniscal BHT than with a non-BHT. CLINICAL SIGNIFICANCE: Meniscal tear morphology influences the presence or absence of meniscal click. Because of the high incidence of meniscal disease, this study provides evidence to support joint exploration in the treatment of CCL disease.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Cães/lesões , Artropatias/veterinária , Traumatismos do Joelho/veterinária , Menisco/lesões , Joelho de Quadrúpedes/patologia , Lesões do Menisco Tibial/veterinária , Animais , Lesões do Ligamento Cruzado Anterior/patologia , Artroscopia/veterinária , Feminino , Artropatias/diagnóstico , Traumatismos do Joelho/diagnóstico , Masculino , Menisco/patologia , Estudos Prospectivos , Lesões do Menisco Tibial/patologia
19.
Orthopade ; 49(3): 248-254, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31784796

RESUMO

BACKGROUND: In 2016, the AG 11 (work group for implant-material-intolerance) of the German society for Orthopaedics and Orthopaedic Surgery (DGOOC) created a histopathologic implant register (HIR). The goal was to conduct a retrospective data analysis based on the revised SLIM-consensus-classification, which defines eight different failure mechanisms. QUESTIONS: The analysis of 4000 cases of endoprosthetic joint replacements addressed the following questions: 1. What is the frequency distribution of different SLIM-types? 2. How does durability of endoprosthetic joint replacements differ among SLIM-types? 3. What kind of periprosthetic malignant neoplasia can be detected and how often? RESULTS: SLIM-type I was diagnosed in 1577 cases (n = 1577, 39.4%), SLIM-type II in 577 cases (n = 577; 14.4%), SLIM-type III in 146 cases (n = 146; 3,7%), SLIM-type IV in 1151 cases (n = 1151; 28.8%), SLIM-type V in 361 cases (n = 361; 9.0%), SLIM-type VI in 143 cases (n = 143; 3.6%), SLIM-type VII in 42 cases (n = 42; 1.0%), and SLIM-type VIII in 3 cases (n = 3; 0.075%). There was statistical significance in implant durability between the different SLIM types. Among the different reasons for endoprosthetic joint replacement failure, non-infectious causes have the biggest share at 81%, with SLIM-type I (39.5%), and SLIM-type IV (29.4%) being the predominant SLIM types. Three cases of periprosthetic malignant neoplasia (SLIM-type VIII) were detected: one case of small B lymphocytic lymphoma/BCLL (C85.9; ICD-O: 9670/3), one case of diffuse large B­cell lymphoma/DLBCL (C83.3; ICD­O 9680/3), and one case of anaplastic large cell lymphoma (C84.7; ICD-O: 9714/3), with the latter ones being the causes for joint replacement , which indicates that malignant neoplasia is a very rare cause of endoprosthetic joint replacement (n = 2; 0.05%). DISCUSSION: These data are complete new, especially as concerns arthrofibrosis (SLIM-type V), adverse inflammatory reactions (SLIM-type VI), and the very rare cases of periprosthetic malignant neoplasia, SLIM-type VIII, as a reason for revision. Since neither the annual review (2017) of the EPRD, nor the national evaluation report (2017) of the IQTIG provide sufficient data, this indicates the relevance of the HIR of the AG 11 of the DGOOC.


Assuntos
Artroplastia de Substituição , Artropatias , Neoplasias , Humanos , Próteses e Implantes , Falha de Prótese , Reoperação , Estudos Retrospectivos
20.
J Photochem Photobiol B ; 202: 111677, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31810037

RESUMO

In this examination, chitosan-silk fibroin/polyethylene terephthalate (CTS-SF/PET), chitosan-silk fibroin/polyethylene terephthalate/hydroxyapatite (CTS-SF/PET/HAP) and chitosan-silk fibroin/polyethylene terephthalate/Silver @hydroxyapatite (CTS-SF/PET/Ag@HAP) scaffolds were prepared by utilizing the plasma splashing procedure. Field emission scanning electron microscopy (FESEM) results demonstrated that the outside of the PET covered with HAP nanoparticles. The cell viability results demonstrated that the number of Mesenchymal stem cells (MSCs) primarily spread out on CTS-SF/PET/Ag@HAP. RT-PCR results demonstrated that there was an upregulated mRNA articulation of osseous development-related properties in the CTS-SF/PET/Ag@HAP composite. The in vivo rabbit animal assessment scores of the CTS-SF/PET/Ag@HAP composite were significantly better than those of the CTS-SF/PET at 1 to 3 months. Both in-vivo and in-vitro results exhibited in this investigation recommend that the cytocompatibility and osseointegration of CTS-SF/PET/Ag@HAP tendon were fundamentally improved by expanding the multiplication of cells and up-regulating the outflow of tendon development-related properties. In conclusion, the CTS-SF/PET/Ag@HAP tendon is a promising candidate for Anterior Cruciate Ligament (ACL) replacement in the future.


Assuntos
Ligamento Cruzado Anterior/fisiologia , Materiais Biocompatíveis/química , Durapatita/química , Nanopartículas/química , Osseointegração , Prata/química , Animais , Materiais Biocompatíveis/farmacologia , Adesão Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Artropatias/reabilitação , Artropatias/terapia , Artropatias/veterinária , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Nanopartículas/toxicidade , Osseointegração/efeitos dos fármacos , Coelhos , Tecidos Suporte/química
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