RESUMO
AIMS: The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model. MATERIALS AND METHODS: A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an in vitro model using paired fresh frozen cadaveric femora. RESULTS: The prevalence of early revision for periprosthetic fracture was 0.34% (1180/337 647) and 44.0% (520/1180) occurred within 90 days of surgery. Implant risk factors included: collarless stem, non-grit-blasted finish, and triple-tapered design. In the in vitro model, a medial calcar collar consistently improved the stability and resistance to fracture. CONCLUSION: Analysis of features of stem design in registry data is a useful method of identifying implant characteristics that affect the risk of early periprosthetic fracture around a cementless femoral stem. A collar on the calcar reduced the risk of an early periprosthetic fracture and this was confirmed by biomechanical testing. This approach may be useful in the analysis of other uncommon modes of failure after THA. Cite this article: Bone Joint J 2019;101-B:779-786.
Assuntos
Artroplastia de Quadril/instrumentação , Fraturas do Quadril/prevenção & controle , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Fenômenos Biomecânicos , Criança , Feminino , Seguimentos , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Sistema de Registros , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
We report on an infant, aged four months, suffering from a severe hemangioma of the left labium majus. We induced systemic treatment with propranolol in off-label-use over a period of 5 1/2 months. A few weeks after onset of the treatment, the size and color of hemangioma was obviously reduced; finally there was an almost complete regression. This result underlines the role of propranolol in treatment of problematic hemangioma.
Assuntos
Hemangioma/tratamento farmacológico , Propranolol/administração & dosagem , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Vaginais/tratamento farmacológico , Feminino , Hemangioma/patologia , Humanos , Recém-Nascido , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Neoplasias Vaginais/patologiaRESUMO
A very high rate of mildly abnormal results on a liver panel of five serum chemistries was observed when these tests were performed on a group of asymptomatic, normal workers. These results often led to lengthy delays in hiring, which benefited neither worker nor employer. Three strategies which markedly reduce the number of false-positive examinations with little or no reduction in test sensitivity are available.
