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1.
Orthop Traumatol Surg Res ; 102(2): 149-53, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26874449

RESUMO

INTRODUCTION: The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device. HYPOTHESIS: Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening. MATERIALS AND METHODS: This retrospective series of 43 reTHA performed between 1994 and 2012 included 43 patients, mean age 66 years old (37-90) with a minimum follow-up of 24months. There were grade 1 (n=24) or 2A (n=19) bone defects according to the Paprosky classification. The causes of revision were: aseptic loosening in 27, septic loosening in 6, malposition of the implant in 7 and periprosthetic fractures in 3. Clinical (Postel Merle d'Aubigné [PMA] and Harris scores), and radiological (subsidence) assessment was performed, as well as survival analysis (with a 95% confidence interval). RESULTS: All components were changed through posterolateral approach without femorotomy. In four cases de-escalation (use of a primary component for secondary revision of a prior revision component) was performed. There were no perioperative fractures or perforations. After a mean 47months (24-134), the mean PMA score increased from 10 (5-15) to 16 (11-18), and the Harris score from 58 (20-80) to 85 (66-96). Radiological assessment did not show any extensive radiolucencies or secondary subsidence. Only 3 components were placed in a varus position, with no clinical consequences. One patient had subsequent revision for recurrent dislocations. Estimated survival at 80months by Kaplan-Meier analysis was 85% (CI 95%: 64-100%). DISCUSSION: There are very few studies in the literature (7 series) on this topic, which shows the reluctance of surgeons to use this technique. Placement of a primary femoral stem requires good metaphyseal bone quality for primary stability. Thus, the indication is limited to Paprosky 1 and 2A stages. Revision surgery must be performed by endofemoral approach requiring good preoperative planning, as well as knowledge of the explanted component and a revision component must be available, if necessary, in the operating room. LEVEL OF EVIDENCE: Retrospective study, level 4.


Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Falha de Prótese/etiologia , Retenção da Prótese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cimentos Ósseos/uso terapêutico , Feminino , Fêmur , Prótese de Quadril/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação/métodos , Estudos Retrospectivos , Resultado do Tratamento
2.
Orthop Traumatol Surg Res ; 101(8 Suppl): S291-5, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26548513

RESUMO

INTRODUCTION: The treatment of acromioclavicular (AC) joint separations is controversial, particularly for Rockwood type III injuries. Rockwood type IV injuries, which correspond to horizontal instability, are very likely under-diagnosed. The objective of this study was to evaluate the inter- and intra-observer reproducibility of the Rockwood classification through an evaluation of standard radiographs, as described in the original article. MATERIAL AND METHODS: This was a prospective radiographic study using protocol-based data from the 2014 symposium of the French Society of Arthroscopy (SFA). Fifteen anonymized radiological records were analysed by six independent examiners on two occasions, 1 week apart. The records consisted of a comparative A/P view of the two acromioclavicular joints (Zanca view), an axillary lateral view and dynamic lateral views (Tauber protocol) to uncover dynamic horizontal instability. A detailed analysis protocol was implemented that included absolute and relative measurements on each view; the relative measurements were used to account for radiographic magnification. RESULTS: The inter- and intra-observer reproducibility on the A/P radiographs was good to excellent. The reproducibility was fair to good on the lateral views, but the measurements varied greatly from one subject to another, and significant errors were found with certain records. The reproducibility of the dynamic views proposed by Tauber was poor to fair. DISCUSSION: Radiographic analysis of AC joint separations is reproducible in the vertical plane, which makes it possible to diagnose Rockwood type II, III and V injuries. On the other hand, static and dynamic analyses in the horizontal plane do not have good reproducibility and do not contribute to make an accurate diagnosis of Rockwood type IV injuries. LEVEL OF EVIDENCE: Level I, Diagnostic study.


Assuntos
Articulação Acromioclavicular/diagnóstico por imagem , Luxações Articulares/classificação , Luxações Articulares/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes
3.
Orthop Traumatol Surg Res ; 101(8 Suppl): S313-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26545944

RESUMO

AIMS: To report and analyze both the surgical and radiographic complications associated with anatomic coracoclavicular (CC) ligament procedures and to evaluate the effect of these complications on patient outcomes. PATIENTS AND METHODS: From July 2012 to July 2013, 116 primary anatomic CC ligament procedures (all arthroscopic endobutton fixations) were performed in 14 different centers. Demographic, surgical, subjective, and radiographic data were prospectively analyzed in 14 centers with a minimum follow-up of 12 months. RESULTS: This series included 96 men and 20 women, mean age 37 years old, with a mean delay to surgery of 10 days. No intraoperative complications were reported. There were 11 complications due to hardware failure resulting in a loss of reduction, 1 coracoid fracture, 7 cases of adhesive capsulitis, 2 local infections, 5 cases of hardware pain. There were significant differences in outcomes between patients who did and did not develop complications: mean CS=71 vs. 93, (P<0.0001). All the parameters of the CS were statistically affected (P<0.0001). Forty-eight patients had persistent dislocation>150% on an AP X-ray which affected the pain and activity CS (P=0.023 and P=0.044). No preoperative predictive factors were identified. These patients could not return to the same level of sports activities due to persistent pain. DISCUSSION: Anatomic procedures to treat AC joint dislocation using CC ligament reconstruction resulted in an overall complication rate of 22.4% and influenced the return to sports. Good to excellent outcomes were reported in patients without complications. CLINICAL SERIES: Level of evidence 4.


Assuntos
Articulação Acromioclavicular/lesões , Artroscopia/efeitos adversos , Fraturas Ósseas/etiologia , Luxações Articulares/cirurgia , Ligamentos Articulares/lesões , Escápula , Infecção da Ferida Cirúrgica/etiologia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Adulto , Idoso , Artroscopia/métodos , Bursite/etiologia , Feminino , Humanos , Fixadores Internos/efeitos adversos , Luxações Articulares/diagnóstico por imagem , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Radiografia , Volta ao Esporte , Tempo para o Tratamento , Falha de Tratamento , Adulto Jovem
4.
Orthop Traumatol Surg Res ; 101(8 Suppl): S297-303, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26514849

RESUMO

BACKGROUND: The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD). HYPOTHESIS: Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone. MATERIAL AND METHODS: A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al. RESULTS: Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p=10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0mm, p=5×10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value=0.19 and p=0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromioclavicular stabilisation in the horizontal plane (p=0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02) and by a higher body mass index (BMI) (p=0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p=0.009). CONCLUSION: This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10days. The weight of the upper limb should be taken into account, with 6weeks of immobilisation to unload the construct in patients who have high BMI values. LEVEL OF EVIDENCE: II, prospective non-randomised comparative study.


Assuntos
Articulação Acromioclavicular/lesões , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/fisiopatologia , Articulação Acromioclavicular/cirurgia , Acrômio/diagnóstico por imagem , Acrômio/cirurgia , Doença Aguda , Adulto , Idoso , Artroscopia/efeitos adversos , Artroscopia/métodos , Índice de Massa Corporal , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Humanos , Fixadores Internos , Luxações Articulares/classificação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Radiografia , Tempo para o Tratamento , Adulto Jovem
5.
Orthop Traumatol Surg Res ; 101(8 Suppl): S305-11, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26470802

RESUMO

INTRODUCTION: Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. METHODS: This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. RESULTS: Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022). CONCLUSION: In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. LEVEL OF PROOF: Level II prospective non-randomized comparative study.


Assuntos
Articulação Acromioclavicular/lesões , Luxações Articulares/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Adulto , Doença Crônica , Clavícula/cirurgia , Feminino , Humanos , Fixadores Internos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Radiografia , Volta ao Esporte , Retorno ao Trabalho , Dor de Ombro/etiologia , Tempo para o Tratamento , Adulto Jovem
6.
Prog Urol ; 11(3): 528-32; discussion 532-3, 2001 Jun.
Artigo em Francês | MEDLINE | ID: mdl-11512471

RESUMO

Uretero-arterial fistulas are exceptional complications: only about forty cases have been reported in the literature. The authors report new two cases of fistula between the common iliac artery and the ureter. One fistula occurred in a context of prolonged ureteric stenting after radiotherapy and pelvic surgery for cancer of the uterus, and the other occurred after an aorto-bifemoral allograft. These fistulas generally occur in a particular clinical context, associating several aetiological factors. The clinical presentation is dominated by often massive and intermittent haematuria. The most useful diagnostic examinations are retrograde ureteropyelography and arteriography. The proposed treatment options (nephrectomy, vascular bypass graft and even embolization) depend on the urgency of the situation and involve both the blood vessel and the urinary tract. The prognosis depends on early diagnosis, but preventive measures can be envisaged to decrease the risk of appearance of these fistulas in high-risk patients.


Assuntos
Artéria Ilíaca , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ureterais/diagnóstico , Doenças Ureterais/terapia , Fístula Urinária/diagnóstico , Fístula Urinária/terapia , Fístula Vascular/diagnóstico , Fístula Vascular/terapia
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