Seudotumor infectado en un paciente con artroplastia de cadera con par de fricción metal-metal / Infected pseudotumour in total hip arthroplasty with metal-on-metal friction couple

La artroplastia total de cadera es el principal tratamiento para la artrosis avanzada de cadera y las complicaciones pueden ser luxación, infección, aflojamiento aséptico y, en menor medida, reacciones adversas al metal. El seudotumor es una complicación poco frecuente con un par de fricción metal-metal. El diagnóstico y el tratamiento correctos son muy importantes para disminuir la morbimortalidad. Presentamos el caso de un hombre de 63 años que había sido sometido a una artroplastia total de cadera con un par de fricción metal-metal, 13 años atrás. Al consultar, tenía una gran masa en el glúteo derecho y parestesias en el territorio ciático homolateral. Se diagnosticó seudotumor asociado a infección periprotésica y el tratamiento definitivo consistió en revisión en un tiempo y la administración de antibióticos. Nivel de Evidencia: IV

Total hip arthroplasty (THA) is the main treatment for advanced hip osteoarthritis and its complications include dislocation, infec-tion, aseptic loosening and, to a lesser extent, adverse reactions to metal. Pseudotumor is a rare complication of THA with a metal-on-metal friction couple; its diagnosis and treatment are extremely important to reduce morbidity and mortality. We present the case of a 63-year-old male patient with a 13-year history of THA with a metal-on-metal friction couple who, at the time of con-sultation, presented a large palpable mass in the right gluteus and paresthesias in the homolateral sciatic nerve. The diagnosis of an infected pseudotumor was reached and treated with hip revision and antibiotic therapy. Level of Evidence: IV

Gait pattern normalization after lateral retinaculum reconstruction for iatrogenic medial patellar instability.

A case of medial patellar instability following Insall's proximal realignment studied pre- and postoperatively by gait analysis is presented. Preoperative gait analysis showed an increased stance time period as well as an increased horizontal braking, heel contact and toe-off vertical peak forces on the affected limb. In our case, gait parameters tended to shift towards a normal value pattern after reconstruction of the lateral retinaculum. We speculate about the importance of the passive restraining structures in patellar stability, in contrast to the role of the muscle function advocated by some authors.

Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia.

BACKGROUND: Reconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia. HYPOTHESIS: Reconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone-quadriceps tendon autograft, or bone-patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months. RESULTS: Thirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores improved from 53.3 to 90.7, Lysholm scores improved from 52.4 to 92.1, and Tegner activity scores improved from 3.1 to 5.1. All improvements were highly statistically significant (P < .001). No statistical difference was found between the postoperative Lysholm, Kujala, and Tegner scores and the degree of dysplasia, graft type, or degree of symptoms. There were 85.3% and 91.1% good and excellent results based on Kujala and Lysholm scores, respectively. No recurrent dislocations have occurred. CONCLUSION: Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia. In addition, reconstruction prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.

Fresh osteochondral allografts for patellofemoral arthritis: long-term followup.

UNLABELLED: Treatment of patellofemoral osteoarthritis in young patients is a challenge for orthopaedic surgeons. Concern about loosening and wear in active young people render arthroplasty more suitable for older patients. Osteochondral allografts may be a good alternative, but reports of experience with such grafts in patellofemoral joints are limited. We retrospectively reviewed our results with fresh osteochondral allografts. Our hypothesis was that these grafts provide relief from osteoarthritis, improve knee function, and delay prosthetic knee replacement. From 1986 to 1999, 14 fresh patellofemoral or patellar allografts were implanted in knees of 11 patients younger than 55 years and diagnosed with advanced secondary osteoarthritis. At last followup (average, 10 years; range, 2.5-17.5 years), eight grafts were in place, four for more than 10 years and two for more than 5 years. Of the nonsurviving allografts, three survived more than 10 years. Radiographs of the knees with intact allografts showed mild or no degenerative changes. Average Knee Society scores improved (preoperative to last followup), with knee scores improving from 46 points (range, 38-60 points) to 82 points (range, 35-100 points) and functional scores from 30 points (range, 10-60 points) to 75 points (range, 20-100 points). Fresh osteochondral allografts can provide relief from the arthritic condition, improve knee function, and delay prosthetic knee replacement. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Case reports: A subtrochanteric femur fracture with long intramedullary femorotibial nail for knee arthrodesis.

We present a case report of a patient who had a transverse subtrochanteric femur fracture develop 2 months after uneventful placement of a long femorotibial intramedullary nail for knee arthrodesis. To date, diaphyseal fracture of a femur already stabilized with an intramedullary nail has not been reported. The possible etiology for this unusual complication is discussed.

Cementless porous-coated sockets without holes implanted with pure press-fit technique.

We evaluated the use of a pure press-fit technique in 220 porous-coated acetabular components without screw holes at mean follow-up of 6.1 years (4-7.5 years). The socket had a 14 degrees enhanced gradient at the periphery and was underreamed by 1 to 2 mm depending on bone quality. The Harris Hip average score was 44.3 (26-70) preoperatively and 93.1 (66-100) at final follow-up. There were no postoperative gaps in any zone. Nonprogressive radiolucent lines were detected in 4 hips. There was no movement or migration of the acetabular component on the follow-up x-rays. Pelvic osteolysis was not observed. Whereas 5 cups (2.3%) had revisions, none was revised for aseptic loosening. The press-fit technique provides stability in appropriate cases avoiding the theoretical complications related to screws or screw holes.

Lateral patellofemoral ligament reconstruction.

Abstract Medial dislocation of the patella is a disabling condition; there are several reports in the literature describing this condition and its association with failed lateral retinacular release. The diagnosis and treatment of medial subluxation of the patella may be difficult. Direct repair or imbrication of the lateral retinaculum provides initial stability but a noticeable increase in medial excursion usually reappears. In this article, we describe a simple and reproducible technique to reconstruct the lateral patellofemoral ligament with autogenous tissue that is based on the basic principles of all ligament reconstruction. Reconstruction of the lateral patellofemoral ligament is useful in eliminating the symptoms related to medial instability of the patella after failed lateral retinacular release; however, it must be considered a salvage procedure because it does not address the pathomechanics that led to the initial patellofemoral symptoms.