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1.
Knee Surg Relat Res ; 33(1): 16, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947470

RESUMO

BACKGROUND: The management of bone defects remains one of the major challenges surgeons are faced with in revision total knee arthroplasty (RTKA). Large and uncontained bone defects are traditionally managed with metaphyseal sleeves that facilitate osseointegration and have reported construct stability. While many studies have presented excellent short-term outcomes using metaphyseal sleeves, less is known on their performance in the longer term. The purpose of this study was to present our mid-term results of the metaphyseal sleeves used in patients undergoing RTKA. MATERIALS AND METHODS: Between January 2007 and January 2015, 30 patients underwent RTKA with the use of a CCKMB prosthesis combined with an osteointegrative sleeve. The main indications for RTKA were instability in 40% of the cases (n = 12), aseptic loosening in 30% (n = 9), infection in 26.7% (n = 8), and "other" in 3.3% (n = 1). The minimal follow-up time was 5 years and the mean follow-up time was 82.4 months (SD = 22.6). Clinical outcomes were assessed by Knee Society scores (KSS), range of motion and rate of re-operation. RESULTS: The mean Knee Society score increased significantly from 72.1 preoperatively to 90.0 postoperatively (p < 0.001). The cumulative incidence of re-operation in our study was 13.3% (n = 4). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. Knee flexion to 90° and more was impossible in seven cases (23.3%) preoperatively and in one case (3.3%) postoperatively. CONCLUSION: Porous-coated metaphyseal sleeves demonstrated excellent rates of survivorship and radiographic ingrowth in the mid-term setting. However, further studies are required to assess their outcomes in the long-term.

2.
Int Orthop ; 45(5): 1199-1204, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33733283

RESUMO

PURPOSE: Knee instability is one of the most common indications for having to undergo revision total knee arthroplasty (RTKA) and can be prevented with adequate implant selection and good surgical technique. Varus-valgus constrained implants (VVC) are indicated for cases of RTKA with absent ligament function in order to provide the necessary stability. While mobile-bearing articulations are thought to decrease the risk of aseptic loosening in comparison to their fixed-bearing counterparts, there is limited data on their outcomes. The purpose of our study is to present the clinical and radiological outcomes for patients undergoing an RTKA procedure with the mobile-bearing VVC implant. METHODS: Between January 2008 to January 2018, 93 patients underwent RTKA with the use of varus-valgus mobile-bearing (VVCMB) prosthesis. The main indications for RTKA were instability 38.7% (n = 36), aseptic loosening 31.2% (n = 29), infection in 26.9% (n = 25), and other 3.3%. The mean follow-up time was 56 months. Clinical outcomes were assessed by knee society scores, range of motion, and rate of re-operation. RESULTS: The mean knee society score increased significantly from 65.52 pre-operatively to 89.65 post-operatively (p < 0.001). The five year cumulative incidence of re-operation in our study was 7.53% (n = 7). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. The number of flexion contractures decreased from n = 23 (24.7%) pre-operatively to n = 11 (11.8%) post-operatively (p < 0.05). CONCLUSION: The VVC mobile-bearing prosthesis demonstrated good clinical outcomes and mid-term survivorship in patients undergoing RTKA. Additional follow-up is required in the long term.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Desenho de Prótese , Falha de Prótese , Amplitude de Movimento Articular , Reoperação
3.
Arch Orthop Trauma Surg ; 140(12): 2101-2107, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33040197

RESUMO

INTRODUCTION: Acetylsalicylic acid (aspirin) is a commonly prescribed medication, especially in the age group of individuals who undergo elective total hip arthroplasty (THA). Preoperative discontinuation of aspirin is believed to reduce intraoperative bleeding and other complications, but it may increase the risk of perioperative cardiovascular events. In this study we have sought to evaluate the safety of continuous aspirin treatment in patients undergoing elective THA. MATERIALS AND METHODS: This is a retrospective analysis of a consecutive cohort who underwent elective THA in a tertiary medical center between 2011 and 2018. The cohort was divided into two groups-one that received continuous preoperative aspirin treatment and one that did not. Blood loss, peri- and postoperative complications, readmissions, and short- and long-term mortality were compared between groups. RESULTS: Out of 757 consecutive patients (293 males, 464 females) who underwent elective primary THA, 552 were in the "non-aspirin" group and 205 were in the "aspirin" group and were not treated preoperative with other medication affecting hemostasis. Perioperative continuation of aspirin treatment did not significantly increase perioperative bleeding, as indicated by changes in hemoglobin levels (P = 0.72). There were no significant differences in short- and long-term mortality (P = 0.47 and P = 0.4, respectively) or other perioperative complications, such as readmission (P = 0.78), deep or superficial infection (P = 1 and P = 0.47, respectively), and cardiovascular events (none in both groups). CONCLUSION: Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. The protective effects of aspirin from postoperative thrombotic and cardiovascular events are well documented. The current findings dispute the need to preoperatively withhold aspirin treatment in patients undergoing elective primary THA.


Assuntos
Artroplastia de Quadril , Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Desprescrições , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antifibrinolíticos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Tromboembolia/epidemiologia , Ácido Tranexâmico/uso terapêutico
4.
Injury ; 51(11): 2658-2662, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32763019

RESUMO

BACKGROUND: Intraoperative use of tranexamic acid (TXA) has been proven to reduce the administration of allogenic blood transfusion in total joint arthroplasty (TJA) patients. Data on TXA efficacy in reducing blood loss in trauma patients undergoing hip hemiarthroplasty are sparse, and its use is not yet well-established. The purpose of this study was to assess the efficacy and safety of intraoperative TXA use in patients undergoing hip hemiarthroplasty as treatment for intracapsular femoral neck fracture. METHODS: This is a historical cohort of patients who underwent hip hemiarthroplasty in a tertiary medical center between 2011 and 2019, with minimum follow-up of one year. The cohort was divided into one group of patients who received intraoperative TXA treatment and another group that did not. Blood loss, peri­ and postoperative complications, readmissions, and short- and long-term mortality were compared between groups. RESULTS: Of the 1722 consecutive patients (601 males and 1121 females) who underwent hip hemiarthroplasty who were included in this study, 504 were in the "TXA" group and 1218 were in the "non-TXA" group. TXA use significantly reduced 30-day mortality (4.6% vs 7.3%, respectively, p < 0.046) and perioperative blood loss, as indicated by changes in hemoglobin levels before and after surgery (Δ-1.38 gr/dL vs Δ-1.76 gr/dL, p < 0.001), and by administration of allogenic blood transfusions (17.5% vs 44.4%, p < 0.001). CONCLUSIONS: Similar to the known effect of TXA in TJA patients, the use of TXA treatment in patients undergoing hip hemiarthroplasty led to a significant reduction in 30-day mortality, in postoperative blood loss and in the proportion of patients requiring allogenic blood transfusions.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Hemiartroplastia , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Masculino , Hemorragia Pós-Operatória , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento
5.
Int Orthop ; 44(10): 1951-1956, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32699933

RESUMO

BACKGROUND: The effect of surgeon experience on accuracy of digital pre-operative planning for total hip arthroplasty (THA) remains unclear. The aims of our study were to compare pre-operative planning accuracy between fellow-trained orthopaedic surgeons and residents and to explore whether surgery indication effects the prediction accuracy. METHODS: We prospectively reviewed 101 patients who underwent pre-operative digital templating for THA in our center from January 2019 to January 2020 with King Mark device. Extracted data included baseline characteristics and indication for primary arthroplasty. Pre-operative digital templating was performed separately by both a fellow-trained surgeon and a resident. Accuracy of each group was compared with the implanted components. RESULTS: The overall adequate pre-operative planning of the acetabular cup (exact or +/-1 size match) by the fellow-trained group was higher compared with the resident's group (77.2 and 64.3% respectively, p = 0.037), whereas the overall adequate pre-operative planning of the femoral stem (exact or +/-1 size match) was higher in the resident's group compared with the fellow-trained group (83.2 and 61.4% respectively, p < =0.001). The fellow-trained group showed better pre-operative planning of complex cases (developmental dysplasia of the hip and avascular necrosis of femoral head) than the resident's group. CONCLUSIONS: The experience of the planner does not significantly affect the accuracy of correctly predicting component sizes. However, in complex cases, fellow-trained surgeons should assist residents in digital pre-operative templating for THA.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Cirurgiões , Acetábulo/cirurgia , Articulação do Quadril/cirurgia , Humanos , Cuidados Pré-Operatórios
6.
Hip Int ; 30(5): 629-634, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296067

RESUMO

PURPOSE: To determine if boney morphology influences the anatomic location of hip fractures in elderly patients. METHODS: All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign. RESULTS: 148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA (p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures (p = 0.013). CONCLUSIONS: Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.


Assuntos
Fraturas do Quadril/etiologia , Fraturas do Quadril/patologia , Acetábulo/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Cabeça do Fêmur/patologia , Colo do Fêmur/patologia , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/patologia , Radiografia
7.
Injury ; 50(2): 398-402, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391072

RESUMO

INTRODUCTION: Direct oral anticoagulation agents (DOACs) are increasingly prescribed to older adults. Concerns for perioperative blood loss dictate cessation of anticoagulation treatment and postponement of surgery until the coagulation system returns to normal state. The goal of this study is to compare the estimates of perioperative blood loss and mortality between patients using DOACs and patients receiving no anticoagultaion, in order to challenge the existing policy and question the need for surgery deferral. MATERIALS AND METHODS: This is a retrospective cohort of patients (age > 65) with proximal hip fractures treated with either closed reduction internal fixation (CRIF, n = 1143; DOAC use n = 60) or hemiarthroplasty (HA, n = 571; DOAC use n = 29). Baseline patient characteristics included age, gender, ASA score, socioeconomic level, type of surgica#1: In general a l treatment, duration of surgery and time from admission to surgery. The effect of anticoagulant prescription on percentage of hemoglobin change, odds of receiving blood transfusions and one-month and one-year mortality was evaluated separately for CRIF and HA patients. RESULTS: Patients receiving DOACs had similar perioperative hemoglobin change, transfusion rates and mortality, compared to subjects without anticoagulants in both CRIF and HA cohorts. DOAC patients undergoing CRIF had a longer delay to surgery (40.2 ± 26.9 vs 31.2 ± 22.2, p = 0.003) and higher mortality rates at one year postoperatively (26.7% vs 16.1%, p = 0.015). CONCLUSIONS: DOAC use was not associated with an increased perioperative blood loss or mortality compared to controls. However, they had to wait longer for surgery, which itself was an independent predictor of mortality. It may be safe to shorten waiting time for surgery in patients using anticoagulation, with the goal to minimize surgery delay.


Assuntos
Anticoagulantes/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Segurança do Paciente , Assistência Perioperatória/métodos , Administração Oral , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Protocolos Clínicos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fraturas do Quadril/fisiopatologia , Humanos , Masculino , Segurança do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Centros de Traumatologia , População Urbana
8.
Orthopedics ; 41(4): e516-e522, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29738596

RESUMO

The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18-64 years), and the mean follow-up was 97 months (range, 26.9-166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [Orthopedics. 2018; 41(4):e516-e522.].


Assuntos
Artroplastia de Quadril/efeitos adversos , Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Osteólise/epidemiologia , Adolescente , Adulto , Fatores Etários , Artroplastia de Quadril/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteólise/diagnóstico por imagem , Osteólise/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Radiografia , Reoperação , Estudos Retrospectivos , Adulto Jovem
9.
Rheumatology (Oxford) ; 57(8): 1472-1480, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29688536

RESUMO

Objectives: Calcium pyrophosphate deposition (CPPD) is associated with osteoarthritis and is the cause of a common inflammatory articular disease. Ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (eNPP1) is the major ecto-pyrophosphatase in chondrocytes and cartilage-derived matrix vesicles (MVs). Thus, eNPP1 is a principle contributor to extracellular pyrophosphate levels and a potential target for interventions aimed at preventing CPPD. Recently, we synthesized and described a novel eNPP1-specific inhibitor, SK4A, and we set out to evaluate whether this inhibitor attenuates nucleotide pyrophosphatase activity in human OA cartilage. Methods: Cartilage tissue, chondrocytes and cartilage-derived MVs were obtained from donors with OA undergoing arthroplasty. The effect of SK4A on cell viability was assayed by the XTT method. eNPP1 expression was evaluated by western blot. Nucleotide pyrophosphatase activity was measured by a colorimetric assay and by HPLC analysis of adenosine triphosphate (ATP) levels. ATP-induced calcium deposition in cultured chondrocytes was visualized and quantified with Alizarin red S staining. Results: OA chondrocytes expressed eNPP1 in early passages, but this expression was subsequently lost upon further passaging. Similarly, significant nucleotide pyrophosphatase activity was only detected in early-passage chondrocytes. The eNPP1 inhibitor, SK4A, was not toxic to chondrocytes and stable in culture medium and human plasma. SK4A effectively inhibited nucleotide pyrophosphatase activity in whole cartilage tissue, in chondrocytes and in cartilage-derived MVs and reduced ATP-induced CPPD. Conclusion: Nucleotide analogues such as SK4A may be developed as potent and specific inhibitors of eNPP1 for the purpose of lowering extracellular pyrophosphate levels in human cartilage with the aim of preventing and treating CPPD disease.


Assuntos
Calcinose/tratamento farmacológico , Pirofosfato de Cálcio/metabolismo , Condrocalcinose/tratamento farmacológico , Condrócitos/patologia , Canais de Potássio Ativados por Cálcio de Condutância Intermediária/farmacologia , Pirofosfatases/antagonistas & inibidores , Calcinose/metabolismo , Calcinose/patologia , Células Cultivadas , Condrocalcinose/metabolismo , Condrocalcinose/patologia , Condrócitos/efeitos dos fármacos , Condrócitos/metabolismo , Colorimetria , Humanos , Immunoblotting , Diester Fosfórico Hidrolases/biossíntese , Pirofosfatases/biossíntese
10.
Isr Med Assoc J ; 17(6): 341-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26233991

RESUMO

BACKGROUND: The surgical treatment of hip fractures remains controversial especially when considering age. OBJECTIVES: To investigate the long-term functional outcomes of displaced subcapital hip fractures that were reduced and surgically fixed using parallel cannulated screws in patients aged 60 years and younger. METHODS: During the period 1996-2005, 27 patients under age 60 with displaced subcapital hip fractures classified as Garden III or IV were treated with fracture reduction and surgical internal fixation using cannulated screws. Patient outcomes were assessed using the Harris Hip Score (HHS) and physical examination. RESULTS: During a follow-up period of 8-17 years 4 of the 27 patients (14.8%) developed non-union/femoral head avascular necrosis and had undergone hip arthroplasty. All reoperations were performed within the first year after fracture fixation, all in the 50-60 year old age group. The revision rate among patients 50-60 years old was significantly higher than that of patients 50 years and younger (40% vs. 0%, P = 0.037). Mean HHS was higher for patients not requiring revision surgery (85.4) than for patients with revision surgery (75.5), but this difference was not significant. CONCLUSIONS: Internal fixation using fracture reduction and cannulated screw fixation is a successful treatment modality for displaced subcapital hip fractures in patients under 50 years old. Patients aged 50-60 may have a higher risk of avascular necrosis or non-union and require arthroplasty, often within the first year after fracture fixation. The long-term outcome following these fractures is good when excluding patients who had early complications.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Adulto , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento , Adulto Jovem
11.
Cytokine ; 73(1): 30-5, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25689620

RESUMO

Galectin-3 is a ß-galactoside-binding lectin that plays an important role in the modulation of immune responses. It has been shown to aggravate joint inflammation and destruction in experimental arthritis. We investigated the role of galectin-3 in TLR-induced cell activation in human synovial fibroblasts (SF) in order to better understand the mechanism(s) of the proinflammatory function of galectin-3 in arthritis. Galectin-3 expression in SF obtained from rheumatoid arthritis and osteoarthritis patients was inhibited by siRNA mediated gene-knockdown. Galectin-3 was also inhibited with modified citrus pectin (MCP), a polysaccharide galectin-3 ligand. Galectin-3 knockdown inhibited TLR-2, -3 and -4-induced IL-6 secretion, but not TLR-2, -3 and -4-mediated matrix metalloproteinase-3 or CC chemokine ligand-5 secretion. When the SF were stimulated with phorbol 12-myristate 13-acetate, a protein kinase C activator that bypasses the membranal receptors, galectin-3 knockdown no longer influenced IL-6 secretion. MCP reduced IL-6 levels in a dose-dependent manner. Our results indicate that galectin-3 is a positive sensor-regulator of TLR-induced IL-6 secretion in human synovial fibroblasts, thus adding new insights into the mechanisms by which galectin-3 augments synovial inflammation. These findings corroborate the potential role of glycan inhibitors of galectin-3 as a therapeutic approach for the treatment of inflammatory arthritis.


Assuntos
Fibroblastos/metabolismo , Galectina 3/metabolismo , Transdução de Sinais , Membrana Sinovial/citologia , Receptores Toll-Like/metabolismo , Quimiocina CCL5/metabolismo , Fibroblastos/efeitos dos fármacos , Técnicas de Silenciamento de Genes , Humanos , Interleucina-6/metabolismo , Lipopeptídeos/farmacologia , Lipopolissacarídeos/farmacologia , Metaloproteinase 3 da Matriz/metabolismo , Transdução de Sinais/efeitos dos fármacos , Acetato de Tetradecanoilforbol/farmacologia
12.
Isr Med Assoc J ; 15(9): 505-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24340843

RESUMO

BACKGROUND: The articular surface replacement (ASR) total hip arthroplasty (THA) was recently recalled from the market due to high failure rates. This modality was used frequently by surgeons at our medical center. OBJECTIVES: To assess the clinical and radiographic outcomes in patients following the surgery and determine the revision rate in our cohort. METHODS: Between 2007 and 2010 139 hips were operated on and evaluated in our clinic. All patients underwent a clinical interview, function and pain evaluation, as well as physical examination and radiographic evaluation. When necessary, patients were sent for further tests, such as measuring cobalt-chromium levels and magnetic resonance hip imaging. RESULTS: With an average follow-up of 42 months the revision rate was 2% (3/139). Patients reported alleviation of pain (from 8.8 to 1.7 on the Visual Analog Scale, P < 0.001), good functional outcomes on the Harris Hip Score, and improved quality of life. Overall satisfaction was 7.86 on the reversed VAS. For patients who required further tests, clinical and radiographic outcomes were significantly poorer than for the rest of the cohort. Average blood ion levels were high above the normal (cobalt 31.39 ppb, chromium 13.32 ppb), and the rate of inflammatory collection compatible with pseudotumors on MRI was 57%. DISCUSSION: While our study favors the use of the ASR implant both clinically and radiographically, some patients with abnormal ion levels and inflammatory collections on MRI might require revision in the future.


Assuntos
Artroplastia de Quadril/métodos , Cromo/sangue , Cobalto/sangue , Imageamento por Ressonância Magnética , Qualidade de Vida , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
13.
Int Orthop ; 37(2): 201-6, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22782378

RESUMO

PURPOSE: Bone-patellar-tendon-bone (BPTB) autografting fixed with metal interference screws (IS) is the gold standard for anterior cruciate ligament (ACL) reconstruction. Advances in surgical technology provide a wide choice of grafts, fixation devices and surgical approaches. METHODS: Two-hundred and sixty-one orthopedic surgeons of ten subspecialties from 57 countries were surveyed on their choice of graft and fixation device, the number of reconstructed bundles, and arthroscopic portal. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications. RESULTS: Hamstring autografting was the most popular choice (63 %), then BPTB (26 %) and allograft (11 %). The anteromedial portal was preferred over the traditional transtibial portal (68 % versus 31 %). Two-thirds reported routinely performing a single-bundle graft reconstruction, compared to one-third who used the double-bundle technique. The Endo-button was the most common graft fixation method (40 %), followed by the bioabsorbable IS (34 %), metallic IS (12 %), rigidfix (10 %) and others (4 %). The preferences of hamstring tendon grafting and the anteromedial portal are not supported in the literature. Responses from North American and European surgeons were different from all the others. CONCLUSIONS: Surgeon preferences in ACL reconstruction differ considerably worldwide. Common practice is not always supported by evidence-based publications.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Traumatismos do Joelho/cirurgia , Tendões/transplante , Ligamento Cruzado Anterior/cirurgia , Enxerto Osso-Tendão Patelar-Osso , Pesquisas sobre Serviços de Saúde , Humanos , Internacionalidade , Transplante Homólogo
14.
Orthopedics ; 35(9): e1302-6, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22955393

RESUMO

The Norton scoring system is used by nurses to evaluate pressure ulcer risk. The authors have previously shown that low admission Norton scale scores (ANSS) are associated with postoperative complications other than pressure ulcers following hip fracture and spine fracture surgery in elderly patients. The purpose of this retrospective, cross-sectional study study was to determine whether low ANSS are associated with postoperative complications other than pressure ulcers following elective total hip arthroplasty (THA) in elderly patients. The medical charts of consecutive elderly (older than 65 years) patients admitted between February 2008 and November 2010 were studied for acute renal failure, cardiovascular events, confusion, pneumonia, pressure ulcers, urinary infection, urinary retention, venous thromboembolism, wound infection, and other complications. The final cohort included 166 patients (108 [65.1%] women; aged 75.2±6.4 years). Overall, 24 (14.5%) patients had low (16 or less) ANSS. Patients with low ANSS had significantly more postoperative complications other than pressure ulcers compared with patients with high ANSS (0.5±0.7 vs 0.2±0.4, respectively; P=.018). Binary regression analysis showed that low ANSS were independently associated with all postoperative complications other than pressure ulcers (P=.039). In addition to predicting pressure ulcer risk, the Norton scoring system may be used for predicting other postoperative complications in elderly patients following elective THA.


Assuntos
Hospitalização/estatística & dados numéricos , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Lesão por Pressão/mortalidade , Índice de Gravidade de Doença , Idoso , Artroplastia de Quadril , Comorbidade , Estudos Transversais , Feminino , Humanos , Israel/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
15.
Arch Gerontol Geriatr ; 55(1): 177-80, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21899900

RESUMO

We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with post-operative complications following spine fracture surgery in the elderly. This was a retrospective cross-sectional study conducted at the division of orthopedic surgery in a tertiary medical center between January 2008 and October 2010. The medical charts of consecutive elderly (≥ 65 years) patients admitted for spine fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, and post-operative complications. Except for pressure ulcers, post-operative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 90 patients: 66 (73.3%) females and 24 (26.7%) males. Mean age for the entire cohort was 78.9 ± 0.7 years. Most patients had lumbar fractures (n=49; 54.4%) or thoracal fractures (n=26; 28.9%). Most patients underwent kyphoplasty (n=65; 72.2%). Mean ANSS was 15.9 ± 0.3, and 29 (32.2%) patients had low (<15) ANSS. Patients with low ANSS had significantly more post-operative complications relative to patients with high ANSS (1.0 ± 0.2 vs. 0.2 ± 0.1; p<0.0001). Among all post-operative complications, urinary tract infection was independently associated with ANSS (p<0.0001). Binary regression analysis showed that ANSS were independently associated with post-operative complications (p=0.001). We conclude that low ANSS are associated with post-operative complications and urinary tract infection in particular, following spine fracture surgery in the elderly. Hence, the Norton scoring system may be used for predicting and preventing post-operative complications in this population.


Assuntos
Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Confusão/epidemiologia , Confusão/etiologia , Estudos Transversais , Feminino , Humanos , Cifoplastia , Masculino , Procedimentos Ortopédicos/estatística & dados numéricos , Admissão do Paciente , Pneumonia/epidemiologia , Pneumonia/etiologia , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fraturas da Coluna Vertebral/epidemiologia , Resultado do Tratamento , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia
16.
Arch Gerontol Geriatr ; 55(1): 173-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21871678

RESUMO

We sought to determine if low ANSS, usually associated with high pressure ulcer risk, are also associated with postoperative complications and in-hospital mortality following hip fracture surgery in the elderly. This was a retrospective cross-sectional study conducted in a tertiary medical center. The medical charts of consecutive elderly (≥ 65 years) patients admitted for hip fracture surgery were studied for the following measurements: ANSS, demographic data, co-morbidities, postoperative complications, the need for revision procedures, and in-hospital mortality. Except for pressure ulcers, postoperative complications included: acute coronary syndrome, acute renal failure, confusion, pneumonia, urinary tract infection, venous thromboembolism, and wound infection. The final cohort included 269 patients: 198 (73.6%) females and 71 (26.4%) males. Mean age for the entire cohort was 82.8 ± 0.4 years. Most patients underwent an internal fixation (n=146; 54.3%) or hemiarthroplasty (n=92; 34.2%). Overall, 110 (40.9%) patients had low (<15) ANSS. Patients with low ANSS had significantly more postoperative complications relative to patients with high ANSS (0.77 ± 0.09 vs. 0.23 ± 0.04; p<0.0001). Among all postoperative complications, urinary tract infection was independently associated with low ANSS (p<0.0001). ANSS were independently associated with postoperative complications (p<0.0001), the need for revision procedures (p=0.019), and in-hospital mortality (p=0.016). We conclude that the Norton scoring system may be used for predicting postoperative complications and in-hospital mortality following hip fracture surgery in the elderly.


Assuntos
Fixação de Fratura/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Confusão/epidemiologia , Confusão/etiologia , Estudos Transversais , Feminino , Fixação de Fratura/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Admissão do Paciente , Pneumonia/epidemiologia , Pneumonia/etiologia , Complicações Pós-Operatórias/mortalidade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia
18.
Harefuah ; 144(3): 211-5, 229, 2005 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-15844463

RESUMO

The cervical spine is injured in 2-3% of major trauma patients. Over the past 15 years there have been dramatic changes in the approach to imaging acute cervical spine trauma. Radiographic clearance for injury must be provided efficiently and accurately. There are numerous choices for clearance that are now in clinical practice: plain radiographs, computed tomography (CT) with multiplanar reformations, and magnetic resonance imaging (MRI). This article reviews the literature on methods of C-spine clearance and emphasizes the pitfalls of each modality. The issue of clinical versus radiographic evaluation of low risk patient is also discussed. An algorithm for the use of advanced imaging in acute trauma situation is proposed.


Assuntos
Traumatismos da Coluna Vertebral/diagnóstico , Doença Aguda , Algoritmos , Humanos , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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