RESUMO
Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.
RESUMO
Abstract Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.
Resumo Objetivo Comparar a taxa de cura, o tempo de recuperação e a pontuação na escala funcional de Merle d'Aubigné-Postel (EFMA) entre a cirurgia em tempo único (C1T) e a cirurgia em dois tempos (C2T) no tratamento de infecções protéticas do quadril, considerando as características sociodemográficas e clínicas dos pacientes. Materiais e Métodos Foi realizado um estudo retrospectivo num único centro, entre 2011 e 2014, com um total de 37 casos estudados, sendo 26 tratados com C1T e 11 com C2T. Foram comparadas a taxa de cura, o tempo de recuperação e a pontuação EFMA entre os dois grupos, bem como as características sociodemográficas e clínicas dos pacientes. Foram também consideradas as complicações cirúrgicas e o agente infeccioso mais comum. Resultados O grupo C1T teve uma recuperação funcional mais rápida do que o grupo C2T, mas não houve diferenças significativas na taxa de cura, nas complicações cirúrgicas ou na pontuação EFMA. No entanto, o grupo C1T era significativamente mais jovem, o que pode ter influenciado os resultados. Staphylococcus spp. foi o agente infeccioso mais comum (62%). Conclusão Embora a C2T pareça ser superior em termos de cura de infecção, a C1T pode ser preferível para uma recuperação funcional mais rápida. No entanto, as características individuais dos pacientes devem ser consideradas na escolha do tratamento. São necessárias mais pesquisas com um tamanho de amostra maior para confirmar estes resultados.
Assuntos
Humanos , Reoperação , Artroplastia de Quadril , Prótese de Quadril , InfecçõesRESUMO
Acetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. The pathophysiological basis of AR is an anterior acetabular hyper-coverage and an overall pelvic rotation.The delay or the non-diagnosis of AR could have an impact in the overall management of femoroacetabular impingement (FAI). AR is a subtype of (focal) pincer deformity.The objective of this review was to clarify the pathophysiological, diagnosis and treatment fundaments inherent to AR, using a current literature review.Radiographic evaluation is paramount in AR: the cross-over, the posterior wall and ischial spine signs are classic radiographic signs of AR. However, computed tomography (CT) evaluation permits a three-dimensional characterization of the deformity, being more reliable in its recognition.Acetabular rim trimming (ART) and periacetabular osteotomy (PAO) are the best described surgical options for the treatment of AR.The clinical outcomes of both techniques are dependent on the correct characterization of existing lesions and adequate selection of patients. Cite this article: EFORT Open Rev 2018;3:595-603. DOI: 10.1302/2058-5241.3.180015.
RESUMO
As sequelas das lesões traumáticas da espinal medula representam um elevado prejuízo pessoal, familiar e social. Desde 1984, foi investigado e proposto o tratamento com succinato sódico metilprednisolona em altas doses, como forma de reverter ou prevenir o agravamento dessas lesões. Apresentamos uma revisão da literatura sobre essa temática. Sabe-se que essa terapêutica tem uma elevada taxa de complicações, mas, acerca das suas vantagens e real eficácia, não existe concordância entre autores de trabalhos. Enquanto uns a defendem, outros chegam a considerar provada a sua total contraindicação nessa patologia. Já existem, em nível mundial, alguns centros que não fazem a sua administração. Em Portugal é prática generalizada a sua utilização. Não o fazer poderia mesmo ser difícil de defender em situação de litígio. Mas será que estamos mesmo a ajudar os nossos doentes?.
Sequelae of the traumatic injuries to the spinal cord represent a high personal, family and social damage. Since 1984, it has been investigated and considered that the treatment with sodium succinate methylprednisolone in high doses was a solution to revert or to prevent the aggravation of such injuries. We present a revision of literature on this subject. It is well established that this therapeutic has a high rate of complications, but concerning its advantages and real effectiveness, there is no agreement between paper authors. While some defend it, others state that this is a total contraindication in this pathology. There are already some medical centers worldwide that do not use it. In Portugal, the practice of its administration is generalized. Not to do it could be difficult to defend in a litigation situation. But are we really helping our patients with it?.
Las secuelas de las lesiones traumáticas de la médula espinal representan una gran pérdida personal, familiar y social. Desde el 1984, se investigó y se ofreció tratamiento con succinato sódico de metilprednisolona en altas dosis, como una forma de revertir o prevenir el empeoramiento de estas lesiones. Los autores presentan una revisión de la literatura sobre este tema. Se sabe que esta terapia tiene un alto índice de complicaciones. Sin embargo, sobre sus ventajas y eficacia real, no hay acuerdo entre las publicaciones. Mientras que algunas la defienden y otros llegan a tomar como prueba de su contraindicación total en esta patología.Ahora, existen en todo el mundo, algunos centros que no hacen su administración. En Portugal, se encuentra en uso generalizado. No hacerlo sería difícil de defender en situaciones de conflicto. ¿Pero, es esto una real ayuda a nuestros pacientes?.
