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1.
Acta Orthop Belg ; 87(3): 427-433, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34808715

RESUMO

The accuracy of pre-operative digital templating for total hip arthroplasty (THA) using the diseased versus unaffected contralateral joint remains unclear. As such, we devised a study to compare templating precision between the operated hip joint versus the healthy side for patients with osteoarthritis (OA). The study hypothesis was that preoperative templating accuracy of THA on the ipsilateral diseased hip joint would be higher compared to the contralateral healthy hip in patients with OA. We retrospectively reviewed 100 patients who underwent THA for unilateral OA at our center from January 2018 to January 2020. Retrospective preoperative digital templating was performed separately on both the operated hip joint and the healthy contralateral hip joint by a single surgeon who was blinded by the in-situ components sizes. Accuracy of each group was compared to the implanted components. Assessment of the 100 included cases demonstrated superior acetabular component size prediction when templating was performed using the diseased hip compared to the healthy contralateral side (68.0% versus 51.0%, p<0.001). No differences between the cohorts were found regarding templating accuracy of femoral stem sizes (72.0% and 69.0%, p=0.375) or neck offset (73.0% and 69.0%, p=0.289). Templating acetabular cup size using the ipsilateral diseased hip is more accurate than using the contralateral healthy hip in patients with unilateral OA.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes , Estudos Retrospectivos
2.
Knee Surg Relat Res ; 33(1): 39, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34715941

RESUMO

PURPOSE: Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. MATERIALS AND METHODS: A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. RESULTS: The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. CONCLUSIONS: A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. LEVEL III EVIDENCE: Retrospective cohort study.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33959801

RESUMO

INTRODUCTION: Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients' outcomes. MATERIALS AND METHODS: The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author. RESULTS: The average age of the study cohort was 73 years (range 28-96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees. CONCLUSION: CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures. IRB APPROVAL: TLV-0292-15. LEVEL OF EVIDENCE: IV.

4.
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.

5.
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
6.
J Orthop ; 24: 15-18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33679022

RESUMO

Introduction: There is no consensus regarding the optimal device for displaced intracapsular hip fractures. This retrospective study compared two techniques (1) cannulated cancellous screw (CCS), and (2) Targon Femoral Neck (TFN) plate. Materials and methods: Data regarding gender, operational data, complications, pain, Quality of life and function scores were retrieved. Results: 103 patients were included, 42 were treated using CCS, compared to 61 treated using TFN. Operative time shorter for CCS (p = 0.019). Complication rates were not different (p > 0.05). Conclusion: As CCS method take shorter operating time and reduced costs, CCS should be used for the treatment of displaced ICHF.

7.
Injury ; 52(6): 1544-1548, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33092856

RESUMO

PURPOSE: Blood loss during and following elective total hip arthroplasty (THA) can be substantial and may require allogeneic blood transfusions which carries significant risks and morbidity for patients. Intraoperative use of tranexamic acid (TXA) has been proven to reduce the need for allogeneic blood transfusion in elective THA patients. Data regarding TXA efficacy in reducing blood loss in trauma patients undergoing non-elective primary THA is sparse, and its routine use is not well established. METHODS: This is a retrospective analysis of a consecutive cohort of patients who underwent non-elective primary THA in a tertiary medical center between January 1st 2011- December 31st 2019. The cohort was divided into two groups; one received perioperative TXA treatment while the other did not. Blood loss, blood product administration, peri and postoperative complications, readmissions and 1-year mortality were compared between groups. RESULTS: A total of 419 patients (146 males, 273 females) who underwent THA were included in this study. The "TXA" group consisted 315 patients compared to 104 patients in the "no TXA" group. TXA use reduced postoperative bleeding, as indicated by changes in hemoglobin levels before and after surgery (ΔHb= -2.75 gr/dL vs. ΔHb= -3.34 gr/dL, p<0.001) and by administration of allogeneic blood transfusions (7.0% vs. 16.3%, p = 0.004). CONCLUSION: Similar to the known effect of TXA in elective THA patients, the use of TXA treatment in patients undergoing non-elective THA led to a significant reduction in postoperative blood loss and in the proportion of patients requiring allogeneic blood transfusions.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ácido Tranexâmico/uso terapêutico
8.
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
9.
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
10.
Bull Hosp Jt Dis (2013) ; 78(3): 187-194, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32857026

RESUMO

BACKGROUND: Obesity has been considered a relative contraindication to performing a direct anterior approach total hip arthroplasty (DAA-THA) since it is hypothesized to lead to component malpositioning and poor outcomes. Fluoroscopy-assisted DAA-THA has been reported to diminish variability in acetabular component positioning. However, fluoroscopy-assisted DAA-THA in the obese patients has not been well described. We report on a single surgeon consecutive series of fluoroscopy-assisted primary DAA-THA's examining the radiographic and perioperative outcomes in obese patients. METHODS: A retrospective review was conducted of 509 consecutive unilateral fluoroscopy-assisted DAA-THAs on a specialized orthopaedic table performed by a single surgeon. All patients were divided into three cohorts according to their body mass index (BMI): Group I (< 30 kg/ m2 ), Group II (≥ 30 to < 35 kg/m2 ), and Group III (≥ 35 kg/ m2 ). Perioperative parameters, outcome scores (EuroQol 5 Dimension and hip disability and osteoarthritis outcome scores), and radiographs were comparatively assessed. Cup position was determined using Widmer's method. RESULTS: A total of 492 DAA-THAs (minimum follow-up: 2.1 years) with appropriate radiographs were analyzed. Of which 356 (72.2%) were in Group I (average: 25.1 kg/m2 ), 105 (21.3%) in Group II (average: 32 kg/m2 ), and 31 (6.5%) in Group III (average: 38.6 kg/m2 ). There were no differences in any parameters between Group II and III. Group I differed in average age and included more female patients than Groups II and III. There was a statistically significant difference in cup anteversion between all groups with average measurements of 20.8°, 19.5°, and 17.6°, respectively. No other differences were identified in radiographic parameters or postoperative outcomes. CONCLUSIONS: There were no clinically relevant differences in component positioning or perioperative parameters between obese and non-obese patients. We do not consider a BMI ≥ 30 kg/m2 to be a contraindication for fluoroscopyassisted DAA-THA when performed by a surgeon experienced in the technique.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril , Articulação do Quadril , Obesidade , Osteoartrite do Quadril , Cirurgia Assistida por Computador/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Índice de Massa Corporal , Feminino , Fluoroscopia/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Ajuste de Prótese/métodos , Radiografia/métodos
11.
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
12.
Clin Biomech (Bristol, Avon) ; 77: 105027, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32447179

RESUMO

BACKGROUND: Long-term survival of hip implants is of increasing relevance due to the rising life expectancy. The biomechanical effect of strain shielding as a result of implant insertion may lead to bone resorption, thus increasing risk for implant loosening and periprosthetic fractures. Patient-specific quantification of strain shielding could assist orthopedic surgeons in choosing the biomechanically most appropriate prosthesis. METHODS: Validated quantitative CT-based finite element models of five femurs in intact and implanted states were considered to propose a systematic algorithm for strain shielding quantification. Three different strain measures were investigated and the most appropriate measure for strain shielding quantification is recommended. It is used to demonstrate a practical femur-specific implant selection among three common designs. FINDINGS: Strain shielding measures demonstrated similar trends in all Gruen zones except zone 1, where the volumetric strain measure differed from von-Mises and maximum principal strains. The volumetric strain measure is in better agreement with clinical bone resorption records. It is also consistent with the biological mechanism of bone remodeling so it is recommended for strain shielding quantification. Applying the strain shielding algorithm on three different implants for a specific femur suggests that the collared design is preferable. Such quantitative biomechanical input is valuable for practical patient specific implant selection. INTERPRETATION: Volumetric strain should be considered for strain shielding examination. The presented methodology may potentially enable patient-specific pre-operative strain shielding evaluation so to minimize strain shielding. It should be further used in a longitudinal study so to correlate between strain shielding predictions and clinical bone resorption.


Assuntos
Prótese de Quadril , Estresse Mecânico , Fenômenos Biomecânicos , Reabsorção Óssea/etiologia , Fêmur/cirurgia , Análise de Elementos Finitos , Humanos , Estudos Longitudinais , Desenho de Prótese
13.
Bull Hosp Jt Dis (2013) ; 77(3): 159-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487479

RESUMO

PURPOSE: The purpose of the study was to investigate clinical outcomes following a mini-open posterior technique. METHODS: Patients who received mini-open popliteal cyst excisions between April 1999 and April 2010 were identified. Charts were retrospectively reviewed for postoperative complications, cyst recurrence, previous aspiration, re-operation, intraoperative findings, cyst size, comorbidities, and co-surgeries. Visual Analogue Pain Scale and Rauschning's symptomatic knee criteria were collected prospectively to assess functional outcomes. RESULTS: Twenty-two legs in 21 patients were included in the study [males: 12 (57%); females: 9 (43%); age: 48.23 ± 11.74 years; BMI: 26.7 ± 4.54 kg/m2; follow-up: 4.55 ± 3.01 years]. Average cyst size was 4.16 ± 1.64 cm and were all located in the posteromedial aspect of the leg. All 22 cases had associated intra-articular pathology based on MRI, physical examination, and arthroscopy. Complications after cyst excision included: paresthesia in the distribution of the saphenous nerve (3/22, 14%), keloid formation (1/22, 4%), joint effusion requiring aspiration (1/22, 4%), and one recurrence requiring cystectomy 10 years later (4%). All incidences of paresthesia resolved. Mean visual analog pain score decreased by 6 points (p < 0.001) and Rauschning and Lindgren score decreased by two categories, from a 2.6 (category 2-3) preoperatively to 0.6 (category 0-1) postoperatively (p < 0.001). CONCLUSION: Mini-open popliteal cyst excision is a safe and effective technique for refractory popliteal cysts in patients who desire a decrease in pain, an increase range of motion, and improved function in knee flexion and extension. Further studies are needed to evaluate the clinical outcomes of patients over a longer duration as our one patient with a 10-year follow-up required a repeat procedure.


Assuntos
Dissecação , Articulação do Joelho , Procedimentos Cirúrgicos Minimamente Invasivos , Cisto Popliteal , Complicações Pós-Operatórias , Artroscopia/estatística & dados numéricos , Dissecação/efeitos adversos , Dissecação/métodos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Cisto Popliteal/diagnóstico , Cisto Popliteal/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação/estatística & dados numéricos , Estados Unidos/epidemiologia
14.
J Arthroplasty ; 34(3): 522-526, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30503321

RESUMO

BACKGROUND: Advancements in the management of human immunodeficiency virus (HIV) now permit HIV-positive patients to have longer life spans, increasing their cumulative risk of developing an advanced degenerative joint disease, necessitating total hip arthroplasty (THA). The purpose of this study was to provide an extended follow-up on a previously published study on a cohort of HIV-positive THA recipients in an effort to confirm the safety and longevity of THA in this population. METHODS: This study is a follow-up on a previous study comprised of 41 hips in 31 HIV-positive THA recipients. At this follow-up, 5 patients from the original cohort required contralateral THA. Postoperative complications were recorded up to the patient's last follow-up date. A survivorship analysis was performed using the Kaplan-Meier method with revision THA as the end point. RESULTS: Since the last report, 2 additional hips were revised (one for aseptic loosening and one for a periprosthetic fracture), and 5 patients underwent contralateral THA. This resulted in a total of 5 (13.8%) hips requiring revision THA at the latest follow-up. The mean follow-up interval for the original cohort and for the contralateral 5 hips was 78.9 ± 50.2 months and 54.6 ± 45.3 months, respectively. Kaplan-Meier survivorship analysis with revision THA for any reason as the end point demonstrated survivorship of 93% (2 years), 90% (5 years), and 81% (10 and 14 years) after primary THA, respectively. CONCLUSION: Our study suggests that it is possible to achieve a low incidence of postoperative infection in HIV-positive THA recipients. In addition, our study demonstrates that non-hemophiliac HIV-positive patients have comparable revision rates to previously published reports on HIV-negative patients of similar age, underscoring the clinical efficacy of highly active antiretroviral therapy.


Assuntos
Artroplastia de Quadril/efeitos adversos , Infecções por HIV/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , HIV , Prótese de Quadril/efeitos adversos , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos
15.
Int Orthop ; 43(8): 1977-1982, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30187099

RESUMO

PURPOSE: This study was designed to compare the results of clavicle fracture open reduction internal fixation (ORIF) with standard horizontal incision versus vertical incision. METHODS: ORIF surgery performed between October 2012 and August 2016 was included. The surgical approach was chosen according to surgeon preference as vertical or horizontal. Functional outcomes, fracture union, complications, scar appearance, skin irritation, and denervation around the scar were assessed at a minimum follow-up of three months. RESULTS: Thirty-eight patients, age 39 ± 12 years, were operated upon, 22 through vertical incisions and 16 through horizontal incisions. There were no significant group differences in functional scores, fracture union, or complications. Two patients in the vertical incision group had a post-operative haematoma. The scar length was significantly shorter when a vertical incision was used (6.75 ± 1.25 cm vs 8.9 ± 2.3 cm, P = 0.001). The typical distribution of hypoesthetic skin area distal and lateral to the scar represented iatrogenic damage to the supraclavicular nerves and was found in 66% of patients. The mean hypoesthetic surface area was smaller in the vertical incision group (38 ± 29 cm2 vs 48 ± 28 cm2, P = non-significant). CONCLUSION: Vertical incision results in shorter scars but may be associated with increased incidence of haematomas. Meticulous closure of the subcutaneous tissue is recommended.


Assuntos
Clavícula/cirurgia , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Adulto , Clavícula/lesões , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ferida Cirúrgica , Resultado do Tratamento
16.
Nat Med ; 24(12): 1867-1876, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30523328

RESUMO

Multiple myeloma, a plasma cell malignancy, is the second most common blood cancer. Despite extensive research, disease heterogeneity is poorly characterized, hampering efforts for early diagnosis and improved treatments. Here, we apply single cell RNA sequencing to study the heterogeneity of 40 individuals along the multiple myeloma progression spectrum, including 11 healthy controls, demonstrating high interindividual variability that can be explained by expression of known multiple myeloma drivers and additional putative factors. We identify extensive subclonal structures for 10 of 29 individuals with multiple myeloma. In asymptomatic individuals with early disease and in those with minimal residual disease post-treatment, we detect rare tumor plasma cells with molecular characteristics similar to those of active myeloma, with possible implications for personalized therapies. Single cell analysis of rare circulating tumor cells allows for accurate liquid biopsy and detection of malignant plasma cells, which reflect bone marrow disease. Our work establishes single cell RNA sequencing for dissecting blood malignancies and devising detailed molecular characterization of tumor cells in symptomatic and asymptomatic patients.


Assuntos
Heterogeneidade Genética , Mieloma Múltiplo/sangue , Neoplasia Residual/sangue , Mieloma Múltiplo Latente/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Sequência de Bases , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Neoplasia Residual/genética , Neoplasia Residual/patologia , Mieloma Múltiplo Latente/genética , Mieloma Múltiplo Latente/patologia
17.
J Orthop Res ; 36(12): 3328-3333, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30129682

RESUMO

Methylphenidate (MP), a widely used and abused stimulant medication for ADHD, negatively affects bone mass. However, previous epidemiological studies demonstrated that MP is not associated with increased incidence of fractures in children, and may even have a protective effect due to behavior modification. This study aimed to investigate the association between MP and fracture risk in a retrospective cohort of healthy military recruits, aged 18-25, with at least 1 year of service between 2008 and 2017. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1-90, 91-180, or 181+ tablets during the study period. The primary outcome was at least one fracture diagnosis during the study. Among 682,110 subjects (409,175 men [60%]), 50,999 (7.5%) had fractures. MP was used by 1,681 (0.4%) men and 2.828 (1%) women. The fracture rates in the no ADHD, untreated ADHD, ADHD 0-90, ADHD 91-180, and ADHD 181+ groups were 10.4%, 16.4%, 8.7%, 4.8% and 5.8% in men, and 3.6%, 7.1%, 4.6%, 4.4% and 3% in women, respectively. Multivariate regression analysis confirmed an inverse dose-response association between MP and fractures in men (p < 0.001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). The study confirms previous literature and demonstrates an inverse dose-response association between MP and fracture risk in men. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3328-3333, 2018.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Fraturas Ósseas/etiologia , Metilfenidato/efeitos adversos , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Relação Dose-Resposta a Droga , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
J Arthroplasty ; 33(10): 3325-3328, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30041989

RESUMO

BACKGROUND: The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. METHODS: Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had since the index procedure. RESULTS: Clinical follow-up averaged 12.9 years with a range of 7-18 years. The average follow-up duration was 12.5 years with a range of 10-17 years. Linear wear was found to be 0.056 ± 0.036 mm/y. Osteolysis was not observed in any of the patients with greater than 10-year radiographic follow-up. Furthermore, only 1 patient required revision surgery following a mechanical fall. CONCLUSION: Our study demonstrates the long-term wear rates associated with HCLPE liners continue to match rates published in midterm studies. Previously, we have reported that this cohort had an average annual wear rate of 0.05 mm/y over 10 years. This most recent report demonstrates a similar wear rate with up to 18-year follow-up.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/estatística & dados numéricos , Osteólise/etiologia , Polietileno , Acidentes por Quedas , Idoso , Feminino , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos
19.
J Bone Joint Surg Am ; 100(11): 930-935, 2018 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-29870443

RESUMO

BACKGROUND: Previous research has detected an increased risk of stress fractures among subjects who reported previous use of methylphenidate. Conversely, stimulant medication use has been associated with traumatic fracture risk reduction, possibly because of the improved control of the underlying symptoms of attention deficit hyperactivity disorder (ADHD). The goal of this study was to investigate the effect of previous methylphenidate use on the incidence of traumatic and stress fractures among combat soldiers with previously treated and untreated ADHD. METHODS: The retrospective cohort included 100,000 combat soldiers recruited to the Israeli Defense Forces from 2005 through 2015. Diagnosis of ADHD and previous exposure to methylphenidate were determined on the basis of self-reported recruitment questionnaires and medical records. Accordingly, the cohort was divided into 3 groups: subjects with ADHD who were previously treated with methylphenidate (n = 689), untreated subjects with ADHD reporting no medication use (n = 762), and controls having no ADHD diagnosis (n = 98,549). Logistic regressions were fitted to determine the odds ratios (ORs) of study subjects for stress and non-stress (traumatic) fractures. Multivariate analysis incorporated baseline characteristics, including age, sex, weight, duration of service, and diagnosis of anemia, at some point during the service. RESULTS: After adjustment for sex, anemia, weight, age, and duration of service, the risk of traumatic fractures was increased in both subjects with treated ADHD (OR, 1.03 [95% confidence interval (CI), 1.00 to 1.05]) and subjects with untreated ADHD (OR, 1.04 [95% CI, 1.02 to 1.07]) compared with controls. Subjects in the treated ADHD group were at a higher risk of stress fractures (OR, 1.04 [95% CI, 1.02 to 1.07]). Interestingly, a diagnosis of anemia was an independent predictor of stress fractures (OR, 1.05 [95% CI, 1.04 to 1.06]). CONCLUSIONS: Methylphenidate use is associated with an increased risk of stress fractures but a decreased risk of traumatic fractures in individuals diagnosed with ADHD. These and previous findings may serve as sufficient basis for screening for other risk factors and perhaps taking prevention measures in all those using stimulant medications, especially those planning to engage in strenuous physical activity. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Fraturas de Estresse/epidemiologia , Metilfenidato/uso terapêutico , Adolescente , Estimulantes do Sistema Nervoso Central/efeitos adversos , Feminino , Fraturas de Estresse/etiologia , Humanos , Incidência , Masculino , Metilfenidato/efeitos adversos , Militares , Estudos Retrospectivos , Adulto Jovem
20.
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
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