RESUMEN
Progressive pseudorheumatoid dysplasia (PPD) is an autosomal recessive hereditary disease of very low prevalence. It is characterized by the affection of multiple joints, generating arthrosis and progressive deformities from a very young age, which significantly affect the quality of life of patients. Its diagnosis is only confirmed by genetic testing, and no specific pharmacological treatment is still available. In the case of hip involvement, one treatment option is arthroplasty. In this case report, we present a 15-year-old boy with bilateral coxarthrosis secondary to PPD who underwent bilateral total hip arthroplasty in two stages. We highlight the characteristics of this rare entity, the intraoperative findings, the functional outcomes, and the impact on quality of life.
La displasia progresiva pseudorreumatoide (DPP) es una enfermedad hereditaria autosómica recesiva, de muy baja prevalencia. Se caracteriza por la afección de múltiples articulaciones, generando artrosis y deformidades progresivas desde muy temprana edad, que afectan considerablemente la calidad de vida de los pacientes. Su diagnóstico sólo se confirma por análisis genéticos y aún no se dispone de tratamiento farmacológico específico. Ante la afectación de la cadera, una opción de tratamiento está representada por la artroplastía. En este reporte de caso, presentamos un joven de 15 años, con coxartrosis bilateral secundaria a DPP, al cual se le realizó una artroplastía total de cadera bilateral, en dos tiempos. Destacamos las características propias de esta extraña entidad, los hallazgos intraoperatorios, sus resultados funcionales y el impacto en la calidad de vida.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Adolescente , Masculino , Artroplastia de Reemplazo de Cadera/métodos , Artropatías/cirugía , Artropatías/congénitoRESUMEN
INTRODUCTION: Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or > 2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS: We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS: The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS: Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.
RESUMEN
INTRODUCTION: Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or >2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up. METHODS: We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up. RESULTS: The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines. CONCLUSIONS: Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.
RESUMEN
This study aimed to identify the variables associated with fixation failure in intertrochanteric fractures treated with cephalomedullary nailing (CMN). We retrospectively analyzed 251 consecutive patients who underwent surgery between January 2016 and July 2019. In order to identify predictors of failure (cut-out, cut-through, and/or nonunion), we analyzed: gender, age, fracture stability (according to the AO/OTA Classification), femoral neck angle (FNA), FNA as compared to the contralateral hip, lag screw position, and tip-apex distance (TAD). The failure rate was 9.6%: there were 10 cut-outs (4%), 7 non-unions (2.8%), and 7 cut-throughs (2.8%). Univariate logistic regression analysis showed that the risk factors for fixation failure were: female sex (p= 0.018), FNA <125° (p= 0.003), a difference in FNA of 7.5° as compared to the contralateral hip on the lateral radiograph (p= <0.0001), superior (p= 0.0141) and anterior position (p= <0.0001) of the lag screw, and TAD >25mm (p= 0.016). According to the multivariate analysis, female gender (OR 12.92 ; p 0.0019), the difference in FNA on the lateral view (OR 1.36; p < 0.001), and the anterior position of the screw in the femoral head (OR14.01;p <0.001) were confirmed as independent predictors of failure. In order to avoid failures in intertrochanteric hip fractures treated with CMN, this study confirmed the importance of achieving an accurate reduction on the lateral plane and avoiding the anterior position of the screw on the femoral head.
Asunto(s)
Fijación Intramedular de Fracturas , Fracturas de Cadera , Humanos , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Estudios Retrospectivos , Clavos Ortopédicos , Fracturas de Cadera/cirugía , Factores de Riesgo , Resultado del TratamientoRESUMEN
INTRODUCTION: the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures. MATERIAL AND METHODS: a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay and non-union). RESULTS: 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio 0.80 increased the chance of consolidation 23.33 times (p = 0.005). CONCLUSION: our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio 0.80) to promote bone healing.
INTRODUCCIÓN: el estándar de oro de tratamiento para la mayoría de las fracturas diafisarias de tibia está representado por el clavo endomedular (CEM). El objetivo de este estudio fue analizar la importancia del diámetro del CEM sobre la consolidación de fracturas diafisarias de tibia. MATERIAL Y MÉTODOS: se realizó un estudio retrospectivo en pacientes con fracturas cerradas de tibia 42 OTA/AO, tratados con un CEM fresado y acerrojado, entre Enero de 2014 y Diciembre de 2020. Las variables analizadas fueron género, edad, comorbilidades, cantidad de cerrojos utilizados, relación clavo/canal (diferencia entre el diámetro del canal medular y clavo), el índice clavo/canal (razón entre diámetro del clavo y el canal medular), en relación con la tasa de consolidación y falla (retardo de consolidación y seudoartrosis). RESULTADOS: la serie final se conformó por 96 pacientes y la tasa de consolidación fue de 91.7% (n = 88). Se observó un diámetro de clavo significativamente mayor en los pacientes que consolidaron respecto a los que fallaron (p = 0.0014), incrementando la posibilidad de consolidación 5.30 (p = 0.04) veces, por cada milímetro que el clavo aumentó su diámetro. Se observó un incremento de probabilidad de consolidación de 13.56 (p = 0.018) veces utilizando un clavo > 10 mm de diámetro. El índice clavo/canal 0.80 aumentó la posibilidad de consolidación 23.33 veces (p = 0.005). CONCLUSIÓN: nuestros hallazgos sugieren que los CEM fresados y acerrojados en fracturas diafisarias de tibia deben colocarse del mayor diámetro posible (> 10 mm y con un índice clavo/canal 0.80) para favorecer la consolidación.
