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1.
Bone Joint J ; 102-B(6_Supple_A): 116-122, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475283

RESUMEN

AIMS: Metaphyseal cones with cemented stems are frequently used in revision total knee arthroplasty (TKA). However, if the diaphysis has been previously violated, the resultant sclerotic canal can impair cemented stem fixation, which is vital for bone ingrowth into the cone, and long-term fixation. We report the outcomes of our solution to this problem, in which impaction grafting and a cemented stem in the diaphysis is combined with an uncemented metaphyseal cone, for revision TKA in patients with severely compromised bone. METHODS: A metaphyseal cone was combined with diaphyseal impaction grafting and cemented stems for 35 revision TKAs. There were two patients with follow-up of less than two years who were excluded, leaving 33 procedures in 32 patients in the study. The mean age of the patients at the time of revision TKA was 67 years (32 to 87); 20 (60%) were male. Patients had undergone a mean of four (1 to 13) previous knee arthroplasty procedures. The indications for revision were aseptic loosening (80%) and two-stage reimplantation for prosthetic joint infection (PJI; 20%). The mean follow-up was four years (2 to 11). RESULTS: Survival free from revision of the cone/impaction grafting construct due to aseptic loosening was 100% at five years. Survival free from any revision of the construct and free from any reoperation were 92% and 73% at five years, respectively. A total of six patients (six TKAs, 17%) required a further revision, four for infection or wound issues, and two for periprosthetic fracture. Radiologically, one unrevised TKA had evidence of loosening which was asymptomatic. In all unrevised TKAs the impacted diaphyseal bone graft appeared to be incorporated radiologically. CONCLUSION: When presented with a sclerotic diaphysis and substantial metaphyseal bone loss, this technique combining diaphyseal impaction grafting with a metaphyseal cone provided near universal success in relation to implant fixation. Moreover, radiographs revealed incorporation of the bone graft and biological fixation of the cone. While long-term follow-up will be important, this technique provides an excellent option for the management of complex revision TKAs. Cite this article: Bone Joint J 2020;102-B(6 Supple A):116-122.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Resorción Ósea/cirugía , Trasplante Óseo , Prótesis de la Rodilla , Complicaciones Posoperatorias/cirugía , Reoperación , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Diáfisis/trasplante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
2.
Niger Postgrad Med J ; 27(2): 143-146, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32295947

RESUMEN

Revision knee arthroplasty is often complicated by the presence of bone loss, making the use of conventional revision implants impossible, due to inadequate bone stock and ligamentous stability. Distal femoral replacement, although traditionally was developed for salvage surgeries for bone tumours, plays an important role in revision surgeries of elderly low-demand adults with marked bone loss and ligamentous instability. Here, we report the case of a 66-year-old female, with a history of bilateral knee replacement 5 years before the presentation, who developed left knee pain, with X-ray features of failed left knee replacement. This patient had a left distal femoral replacement and successfully returned to her pre-operative function.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Resorción Ósea/cirugía , Fémur/cirugía , Articulación de la Rodilla/cirugía , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/etiología , Femenino , Fémur/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Nigeria , Falla de Prótesis , Reoperación/métodos , Resultado del Tratamiento
3.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
4.
PLoS One ; 14(8): e0221056, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31469844

RESUMEN

OBJECTIVE: Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. DESIGN: The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. RESULTS: AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages. CONCLUSIONS: Our study revealed a differential inflammation signature between AL and non-AL stages of TKA. It also highlighted the unique patient's response to TKA in non-AL stages. Further confirmation of our preliminary results on a larger cohort is needed. Analysis of the time-axis of processes ongoing around TKA implantation may help to understand the mechanisms driving periprosthetic bone resorption needed for diagnostic/preventative strategies.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Resorción Ósea/fisiopatología , Citocinas/metabolismo , Inflamación/metabolismo , Falla de Prótesis/efectos adversos , Anciano , Anciano de 80 o más Años , Resorción Ósea/complicaciones , Resorción Ósea/metabolismo , Resorción Ósea/cirugía , Femenino , Histiocitos/metabolismo , Histiocitos/patología , Humanos , Inflamación/complicaciones , Inflamación/fisiopatología , Inflamación/cirugía , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Persona de Mediana Edad , Osteoclastos/metabolismo , Osteoclastos/patología , Reoperación
5.
Biomed Res Int ; 2019: 4934128, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31317031

RESUMEN

Introduction: With an increasing demand for orthodontic treatment for adult patients, orthodontic professionals are constantly seeking novel strategies and technologies that can accelerate tooth movement in order to shorten the treatment period. For instance, in recent years, the influences of different surgical techniques on orthodontic tooth movement in the ipsilateral side of surgery were intensively investigated. Here, we attempt to examine if corticotomy could also affect the rate of tooth movement in the contralateral side of the surgery by using a rodent model. Materials and Methods: 72 eight-week-old Sprague-Dawley rats were randomly divided into three groups as follows: the Control group (orthodontic treatment devices delivered only, no tooth movement), the orthodontic tooth movement (OTM) group (orthodontic treatment devices delivered and orthodontic treatment performed), and the Corticotomy + OTM group (remote corticotomy performed, orthodontic treatment devices delivered, followed by orthodontic treatment). The surgical procedure was conducted on the right side of the maxilla at the time of appliance placement and a force of 60 g was applied between the maxillary left first molar and maxillary incisors using nickel-titanium springs to stimulate OTM. The OTM distance and speed were tracked at 3, 7, 14, and 28 days post-surgery, followed by histological and immunohistochemical assessments. Results: In comparison with orthodontic treatment only, the contralateral corticotomy significantly accelerated OTM. Furthermore, animals undergoing corticotomy + OTM presented with a greater number of osteoclasts on the compression side, stronger staining of the osteogenic marker on the tension side, and higher expression of an inflammatory marker than the OTM group animals. Conclusion: Our current study demonstrates that remote corticotomy effectively accelerates alveolar bone remodeling and OTM. The study enriches our understanding of the regional acceleratory phenomenon (RAP) and offers an alternative strategy for accelerating OTM to shorten the orthodontic treatment period.


Asunto(s)
Remodelación Ósea/efectos de los fármacos , Resorción Ósea/cirugía , Incisivo/cirugía , Osteogénesis/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Humanos , Incisivo/crecimiento & desarrollo , Incisivo/patología , Maxilar/crecimiento & desarrollo , Maxilar/patología , Maxilar/cirugía , Diente Molar/crecimiento & desarrollo , Diente Molar/patología , Diente Molar/cirugía , Níquel/uso terapéutico , Alambres para Ortodoncia , Osteoclastos/metabolismo , Osteoclastos/patología , Ratas , Titanio/uso terapéutico , Técnicas de Movimiento Dental
6.
Am J Orthod Dentofacial Orthop ; 156(1): 125-136, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256825

RESUMEN

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.


Asunto(s)
Tirantes , Prótesis Articulares , Cóndilo Mandibular/cirugía , Mordida Abierta/cirugía , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Puntos Anatómicos de Referencia , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Resorción Ósea/terapia , Cefalometría , Estética Dental , Femenino , Humanos , Imagenología Tridimensional , Mandíbula/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Maxilar/cirugía , Mordida Abierta/diagnóstico por imagen , Aparatos Ortodóncicos , Aparatos Ortodóncicos Fijos , Ortodoncia Correctiva/instrumentación , Osteotomía , Planificación de Atención al Paciente , Radiografía Panorámica , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento
7.
Surg Technol Int ; 34: 445-450, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31037719

RESUMEN

Acetabular bone loss is common during revision total hip arthroplasty (THA). A new acetabular shell was developed with a goal of maintaining native hip center-of-rotation (COR) while achieving good fixation with standard instrumentation and technique. Previous radiographic studies have demonstrated the efficacy of this shell in lowering hip COR. In this case series, we demonstrate the use of this shell in patients undergoing difficult revision THAs. Based on these cases, we have presented how this offset COR acetabular shell may help bring down the hip COR in patients who undergo revision total hip arthroplasty with severe bone loss.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Resorción Ósea/cirugía , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Resorción Ósea/etiología , Humanos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Rotación
8.
Am J Orthod Dentofacial Orthop ; 155(4): 560-571, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30935611

RESUMEN

INTRODUCTION: We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right. METHODS: The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning. RESULTS: The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved. CONCLUSIONS: The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.


Asunto(s)
Resorción Ósea/cirugía , Mordida Abierta/cirugía , Aparatos Ortodóncicos Fijos , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/terapia , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Mordida Abierta/complicaciones , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Aparatos Ortodóncicos , Ortodoncia Correctiva/instrumentación , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia
9.
Acta Neurochir (Wien) ; 161(3): 483-491, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30617716

RESUMEN

BACKGROUND: Changes after reimplantation of the autologous bone have been largely described. However, the rate and the extent of resorption in cranial grafts have not been clearly defined. Aim of our study is to evaluate the bone flap resorption (BFR) after cryopreservation. METHODS: We retrospectively reviewed 27 patients, aged 18 years or older, subjected to cranioplasty (CP) adopting autologous cryopreserved flap. The BFR was derived from the percentage of decrease in flap volume (BFR%), comparing the first post-operative computed tomography (CT) and the last one available (performed at least 1 year after surgery). We also proposed a semiquantitative scoring system, based on CT, to define a clinically workable BFR classification. RESULTS: After a mean ± SE follow-up of 32.5 ± 2.4 months, the bone flap volume decreased significantly (p < 0.0001). The mean BFR% was 31.7 ± 3.8% and correlated with CT-score (p < 0.001). Three BFR classes were described: mild (14.8% of cases) consisting in minimal bone remodelling, CT-score ≤ 6, mean BFR% = 3.5 ± 0.7%; moderate (51.9% of cases) corresponding to satisfactory cerebral protection, CT-score < 13, mean BFR% = 25.6 ± 2.2%; severe (33.3% of cases) consisting in loss of cerebral protection, CT-score ≥ 13, mean BFR% = 54.2 ± 3.9%. Females had higher BFR% than males (p = 0.022). BFR classes and new reconstructive surgery were not related (p = 0.58). CONCLUSIONS: BFR was moderate or severe in 85.2% of re-implanted cryopreserved flaps. The proposed CT-score is an easy and reproducible tool to define resorption extent.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Craniectomía Descompresiva/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Resorción Ósea/clasificación , Resorción Ósea/cirugía , Criopreservación , Craniectomía Descompresiva/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cráneo/cirugía , Colgajos Quirúrgicos/patología , Colgajos Quirúrgicos/cirugía , Tomografía Computarizada por Rayos X , Trasplante Autólogo
10.
Int Orthop ; 43(1): 117-122, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30327935

RESUMEN

PURPOSE: Our study aims at the evaluation of the recently introduced Lima Promade custom-made acetabular device for the treatment of complex acetabular Paprosky 3B defects. METHODS: Between 2016 and 2018, eight patients with major acetabular osteolysis and multiple revisions history were treated with a custom-made implant in a single centre and by a single surgeon. We assessed patients' demographics, peri-operative data, and complications and a specific questionnaire was submitted to the surgeon after each procedure. RESULTS: All the devices were correctly positioned. In two over eight cases, a post-operative dislocation occurred, where extensive soft tissue impairment was present. The questionnaire showed a good pre-operative and intra-operative experience of the surgeon. CONCLUSIONS: The Promade custom-made acetabular system showed encouraging results for complex defects and the entire procedure was positively rated. Further analysis with a higher number of cases and a longer follow-up should be performed for a complete clinical and cost-effective evaluation.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Resorción Ósea/cirugía , Prótesis de Cadera , Luxaciones Articulares/cirugía , Osteólisis/cirugía , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Resorción Ósea/etiología , Trasplante Óseo , Diseño Asistido por Computadora , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Osteólisis/etiología , Impresión Tridimensional , Diseño de Prótesis , Reoperación , Encuestas y Cuestionarios
11.
J Shoulder Elbow Surg ; 28(1): e1-e9, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30201217

RESUMEN

BACKGROUND: Revision shoulder arthroplasty in the setting of glenoid bone loss poses substantial surgical challenges. This study's purpose was to compare radiographic and clinical results of patients requiring structural iliac crest bone autograft (ICBA) for severe bone loss versus patients with less severe bone loss treated with nonstructural bone allograft (NSBA) in the setting of revision reverse total shoulder arthroplasty (RSA). METHODS: A retrospective cohort of 30 patients (70% of the 43 patients who met the inclusion criteria) undergoing revision RSA with ICBA (n = 15) or NSBA (n = 15) between 2007 and 2015 were analyzed at a minimum 2-year follow-up. Radiographic assessment included bone graft integration, bone graft resorption, glenosphere tilt, glenosphere version, and the presence of scapular notching. Clinical assessment included active range of motion, Penn Shoulder Score, Veterans RAND 12-item health survey, and need for revision surgery. RESULTS: No radiographic difference was found between the ICBA and NSBA groups with regard to implant position, graft integration, scapular notching, implant shift, or failure of fixation (P > .05). Of 15 patients with ICBA, 14 (93%) had at least partial integration of the bone graft. Some degree of resorption of the bone graft was noted in 6 of 15 patients (40%). There was no significant difference in postoperative active range of motion, Penn Shoulder Score, or Veterans RAND 12-item health survey score (P > .05 for all comparisons). One patient in the ICBA group underwent revision surgery for glenoid baseplate failure. CONCLUSION: Revision RSA with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up. Patients requiring structural ICBA were not at increased risk of component failure, radiographic or clinical complications, or inferior clinical outcomes.


Asunto(s)
Artroplastía de Reemplazo de Hombro/métodos , Resorción Ósea/cirugía , Trasplante Óseo/métodos , Ilion/trasplante , Articulación del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Reoperación/métodos , Estudios Retrospectivos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Trasplante Autólogo , Resultado del Tratamiento
12.
Int Orthop ; 43(1): 123-132, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30467646

RESUMEN

BACKGROUND: The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. METHODS: We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves. RESULTS: At a mean follow-up of 13.7 months (range, 6-26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. CONCLUSION: 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedades Óseas/cirugía , Neoplasias Óseas/cirugía , Resorción Ósea/cirugía , Artropatías/cirugía , Impresión Tridimensional , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Enfermedades Óseas/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Resorción Ósea/diagnóstico por imagen , Niño , Estudios de Factibilidad , Femenino , Humanos , Artropatías/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
13.
Int Orthop ; 43(1): 209-215, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30280216

RESUMEN

PURPOSE: Management of acute open tibial fractures with critical bone defect remains a challenge in trauma surgery. Few and heterogeneous cases have been reported about the treatment with the induced membrane technique. METHODS: We prospectively evaluated three patients treated with the induced membrane technique for acute Gustilo IIIB tibial fractures with critical bone defect. Success treatment was defined by bone union with patient pain free. Clinical and radiological evaluations were performed regularly until healing, then annually and with a minimum follow-up of five years. RESULTS: In all patients but one, a success was recorded, respectively, at four and six months. These two patients were pain free until the final follow-up, and no graft resorption or secondary complications related to the index surgery were observed. The third case was managed successfully with a bone transport technique. CONCLUSION: The induced membrane technique is an alternative good option for the treatment of these severe lesions.


Asunto(s)
Resorción Ósea/cirugía , Fijación de Fractura/métodos , Fracturas Abiertas/cirugía , Tibia/cirugía , Fracturas de la Tibia/cirugía , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Resorción Ósea/etiología , Trasplante Óseo/métodos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fracturas Abiertas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos/irrigación sanguínea , Tibia/patología , Fracturas de la Tibia/complicaciones , Resultado del Tratamiento
14.
Cranio ; 37(2): 111-120, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29078737

RESUMEN

OBJECTIVE: To evaluate treatment outcomes for patients with TMJ adolescent internal condylar resorption (AICR) treated by a specific surgical protocol, including: (1) Removal of bilaminar tissue surrounding the condyle, (2) Articular disc repositioning with Mitek anchor technique, and (3) Concomitant orthognathic surgery. METHODS: This study evaluated 24 AICR patients treated by the specific surgical protocol with clinical subjective and objective examinations and lateral cephalogram assessments for surgical changes and long-term outcomes. RESULTS: Mean age at diagnosis was 16.5 years, and mean follow-up was 30.3 months. All 24 patients had significant reduction in TMJ pain, facial pain, and headaches, with improvement in jaw function, diet, and disability. Cephalometric analysis showed significant surgical changes but good long-term occlusal and skeletal stability. CONCLUSION: Patients with AICR treated with the specific surgical protocol demonstrated good skeletal and occlusal stability as well as improvement in TMJ pain, headaches, jaw function, diet, and disability.


Asunto(s)
Resorción Ósea/cirugía , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Cranio ; 37(1): 35-44, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29125402

RESUMEN

BACKGROUND: Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation. Clinical and imaging presentation: The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement. Treatment protocol: AICR can be successfully treated when the condyles and discs are salvageable with the following surgical protocol: (1) Removal of bilaminar tissue surrounding the condyle; (2) Reposition the disc with the Mitek anchor technique; and (3) Orthognathic surgery to advance the maxillo-mandibular complex in a counterclockwise direction. CONCLUSION: AICR can be successfully treated using the specific protocol presented herein to provide stable and predictable outcomes.


Asunto(s)
Resorción Ósea/cirugía , Cóndilo Mandibular/cirugía , Cirugía Ortognática/métodos , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Adolescente , Resorción Ósea/diagnóstico , Resorción Ósea/etiología , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Radiografía Dental , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/etiología
16.
J Craniofac Surg ; 29(8): 2218-2219, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30320696

RESUMEN

Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.


Asunto(s)
Resorción Ósea/rehabilitación , Implantes Dentales , Ilion/trasplante , Maxilar/patología , Maxilar/cirugía , Aumento de la Cresta Alveolar/métodos , Atrofia/rehabilitación , Atrofia/cirugía , Resorción Ósea/cirugía , Implantación Dental Endoósea , Humanos , Masculino , Persona de Mediana Edad , Oseointegración , Trasplante Autólogo
17.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 35(3): 19-28, jul.-sept. 2018. ilus, tab
Artículo en Español | IBECS | ID: ibc-175468

RESUMEN

Objetivo: Evaluar la incidencia de complicaciones y la calidad de vida tras la cirugía en dos grupos de pacientes sometidos a artroplastia total de cadera no cementadas con vástagos corto y con vástagos estándar. Material y Métodos: Se realiza un estudio retrospectivo sobre un total de 106 artroplastias total de cadera implantadas en el Hospital Universitario de Puerto Real entre 2011 y 2015. Se comparan las siguientes variables: estancia hospitalaria, necesidad de transfusión sanguínea, complicaciones mecánicas, necesidad de revisión por cualquier causa, parámetros radiológicos (reabsorción del calcar, hundimiento, dismetría postquirúrgica, metría de cuello remanente) y dolor en cara anterior de muslo en dos grupos homogéneos de 63 vástagos convencionales anatómicos no cementados con 43 vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral ("partial collum"), implantadas por un mismo cirujano. Para el análisis estadístico se utilizó la T de Student para el análisis de variables cuantitativas y Chi cuadrado para variables cualitativas. Resultados: Los resultados muestran diferencias estadísticamente significativas (p< 0.05) en cuanto a variables estancia hospitalaria postquirúrgica, fracturas periprotésicas, dismetría, complicaciones mecánicas y metría del cuello remanente. Conclusiones: Los resultados avalan el empleo de vástagos cortos de estabilización metafisaria y preservación parcial del cuello femoral en pacientes jóvenes con adecuada calidad ósea y bien seleccionados, dadas las ventajas clínicas que suponen


Objetives: To evaluate the incidence of complications and the quality of life after surgery in two groups of patients undergoing total hip arthroplasty not cemented with a short stem and with a standard uncemented stem. Material and Methods: A retrospective study was performed in a total of 106 total hip arthroplasties implanted in the University Hospital of Puerto Real between 2011 and 2015. The following variables are compared: hospital stay, need for blood transfusion, mechanical complications, need for revision for any reason , radiological parameters (calcar resorption, subsidence, postsurgical dysmetria, remnant neck metrics) and anterior thigh pain in two homoge-nous groups of 63 conventional uncemented anatomical stems with 43 short stems of metaphyseal stabilization and partial femoral neck preservation ("Partial collum"), implanted by the same surgeon. For the statistical analysis, T Student was used for the analysis of quantitative variables and Chi-square for qualitative variables. Results: The results show statistically significant differences (p < 0.05) in terms of postsurgical hospital stay variables, periprosthetic fractures, dysmetria, mechanical complications and metrics of the remaining neck. Conclusions: The results support the use of short stems of metaphyseal stabilization and preservation of the greater trochanter in young patients with adequate bone quality given the clinical advantages they imply


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Calidad de Vida , Resorción Ósea/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/clasificación , Estudios Retrospectivos , Tiempo de Internación , Transfusión Sanguínea , Resorción Ósea/cirugía , Prótesis de Cadera
19.
Oral Maxillofac Surg Clin North Am ; 30(3): 355-367, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30008344

RESUMEN

Young females with retruded and hyperdivergent mandibles, class II openbite malocclusions, and steep occlusal planes with or without TMJ symptoms are at higher risk for Idiopathic Condylar Resorption (ICR). Such patients undergoing orthodontic and /or surgical treatment should be informed of possible relapse due to ICR. Orthognathic Surgery with Total joint replacement or Orthognathic surgery alone may both be acceptable options for management of the facial deformity and the malocclusion that ensues from ICR. Proper patient selection is key to achieving a successful outcome. Current trends and the evidence in the literature suggest that orthognathic surgery with alloplastic joint replacement may be the preferred approach.


Asunto(s)
Artroplastia de Reemplazo/métodos , Resorción Ósea/cirugía , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Resorción Ósea/patología , Humanos , Prótesis Articulares , Cóndilo Mandibular/patología , Trastornos de la Articulación Temporomandibular/patología
20.
Mol Med Rep ; 18(2): 2387-2398, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29916540

RESUMEN

Osteoclasts (OCs) are resorptive cells responsible for bone erosion in diseases, including osteoporosis, periodontitis and rheumatoid arthritis. Montelukast is a cysteinyl leukotriene receptor 1 (CysLTR1) antagonist clinically used for the treatment of asthma. In the present study, the role of CysLTR1 on OC formation and bone loss was investigated using montelukast. Montelukast inhibited receptor activator of nuclear factor­κB ligand (RANKL)­induced OC formation in cultures of mouse bone marrow macrophages. Additionally, montelukast suppressed actin ring formation and bone resorption activity of differentiated OCs. The inhibitory effect of montelukast was associated with impaired activation of extracellular signal­regulated kinase, AKT serine/threonine kinase, and/or phospholipase Cγ2 signaling pathways downstream of RANK, followed by decreased expression of nuclear factor of activated T cells c1. Notably, OC formation was efficiently restored by addition of adenosine diphosphate, a P2Y12 agonist, as well as by addition of CysLT. Furthermore, similar to montelukast, P2Y12 blockade by a pharmacological inhibitor or siRNAs suppressed OC differentiation. These data indicate the involvement of the P2Y12 receptor in the inhibitory effect of montelukast on osteoclastogenesis. In vivo, montelukast significantly inhibited inflammation­induced osteoclastogenesis in the calvarial model. Montelukast also served a protective role in a murine ovariectomy (OVX)­ and unloading­induced bone loss model. Altogether, these results confirmed that the CysLTR1 antagonist exerted an inhibitory effect on OC formation in vitro and in vivo. It may be useful for the treatment of bone diseases associated with excessive bone resorption.


Asunto(s)
Acetatos/administración & dosificación , Resorción Ósea/tratamiento farmacológico , Quinolinas/administración & dosificación , Receptores de Leucotrienos/genética , Receptores Purinérgicos P2Y12/genética , Animales , Células de la Médula Ósea/efectos de los fármacos , Resorción Ósea/genética , Resorción Ósea/patología , Resorción Ósea/cirugía , Diferenciación Celular/genética , Humanos , Macrófagos/efectos de los fármacos , Ratones , Osteoclastos/efectos de los fármacos , Osteoclastos/metabolismo , Ovariectomía , Ligando RANK/genética , Transducción de Señal/efectos de los fármacos
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