RESUMO
Loosening of the acetabular cup component in total hip arthroplasty (THA) remains a source of ongoing concern. Threaded cup acetabuloplasty (TCA) utilizes torque and compression to gain purchase of the acetabular cup into the bony margin of the acetabulum. In an earlier study of 121 patients who had THA with TCA, patient assessments and roentgenograms were examined at an average of 30 months after surgery. Twenty percent of the cases were carried out for failed arthroplasty and 20% of the procedures required bone-graft reconstruction. A 22% incidence of moderate to severe postoperative pain, a 3% incidence of cup dislodgement, and a 24% incidence of radiolucencies between 1-2 mm were observed. The four cup dislodgements occurred in patients with severe osteopenia or in those requiring extensive bone-graft acetabular reconstruction. Good clinical results were obtained for osteoarthritic patients treated with primary THA. These early findings suggest that there is no advantage, but there are possible disadvantages, to threaded cup acetabuloplasty when compared to cup fixation with cement.
Assuntos
Acetábulo , Prótese de Quadril , Desenho de Prótese , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/cirurgia , Comportamento do Consumidor , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Falha de Prótese , Radiografia , Estudos RetrospectivosRESUMO
A 17-year-old boy had low back pain for four months prior to the development of sacral osteomyelitis, which led to the initial diagnosis of Crohn's disease. Musculoskeletal problems occur in about one-third of the patients with Crohn's disease. Only a few patients with osteomyelitis complicating Crohn's disease have been reported. This case is rare because he had had no gastrointestinal symptoms. This patient illustrates the point that musculoskeletal signs and symptoms, including osteomyelitis, may prove to be a manifestation of gastrointestinal tract disease.
Assuntos
Doença de Crohn/complicações , Osteomielite/etiologia , Sacro , Adolescente , Doença de Crohn/diagnóstico , Humanos , Masculino , Osteomielite/diagnósticoRESUMO
The use of arthrodesis to salvage failed total knee arthroplasty is reviewed in nine patients. Prosthetic failure was due to infection in six cases, aseptic loosening in two cases, and instability in one case. The techniques of arthrodesis included six Hoffman external fixators, two fluted intramedullary rods (3M-Orthopedic Products Division, St Paul), and one pulsing electromagnetic field stimulator. Arthrodesis was successful in eight of nine patients, averaging 5.4 months to union. All eight patients resumed a painfree functional level of activity. Meticulous surgical technique and appropriate method of arthrodesis are emphasized.
Assuntos
Artrodese/métodos , Prótese do Joelho/efeitos adversos , Idoso , Artrite Reumatoide/cirurgia , Humanos , Instabilidade Articular/complicações , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Radiografia , Reoperação , Infecção da Ferida Cirúrgica/complicaçõesRESUMO
The use of a primary prosthetic replacement such as an Austin-Moore hemi-arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post-operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi-arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri-operative data were reviewed and evaluated using computer-aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi-arthroplastic replacement included: pre-injury nursing home residence, pre-injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P less than 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non-nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi-arthroplasty. Possibly the previously reported increased post-operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure.
Assuntos
Fraturas do Colo Femoral/cirurgia , Nível de Saúde , Saúde , Fatores Etários , Idoso , Raquianestesia , Creatinina/sangue , Eletrocardiografia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Prótese de Quadril/efeitos adversos , Humanos , Locomoção , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Estudos RetrospectivosRESUMO
In a retrospective study of total hip replacement (THR) arthroplasty in patients with renal transplants, femoral head avascular necrosis (AVN) was found in 19 of 138 (15%) patients. Nine THRs in eight of these 19 patients (average age, 47 years) were studied. Preoperatively, all patients had hip pain due to AVN and a history of long-term treatment with systemic corticosteroids. Six of the eight patients had been treated with parenteral pulsed steroids on three occasions, and the other two patients on one occasion, for rejection episodes. All patients showed some degree of femoral head collapse roentgenographically. There were no major surgical complications. All patients had markedly improved functional capacities and relief of pain. With follow-up averaging three years, there has been no evidence of component loosening.
Assuntos
Prótese de Quadril , Transplante de Rim , Corticosteroides/efeitos adversos , Adulto , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/cirurgia , Seguimentos , Quadril/diagnóstico por imagem , Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia , Estudos RetrospectivosRESUMO
This unusual case of trauma depicts a 17-year-old female who had a history of chronic synovitis of her left knee for several months. The patient demonstrated persistent knee effusion despite treatment of several physicians. Failure of the left knee to respond to several surgical procedures, as well as the finding of numerous foreign bodies not present previously, evoked a high index of suspicion leading to the diagnosis of factitial synovitis. The paper further defines the entity, describes the personalities involved and the numerous methods used to inflict trauma. Lastly, the treatment regime is given.