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1.
BMC Surg ; 21(1): 9, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407340

RESUMO

BACKGROUND: This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). METHODS: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9-6.1 years). RESULTS: The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22-38) to 87.5 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4-9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6-67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2-53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. CONCLUSIONS: THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.


Assuntos
Artroplastia de Quadril , Luxação Congênita de Quadril , Adulto , Idoso , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Estudos Retrospectivos
2.
J Arthroplasty ; 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33248922

RESUMO

BACKGROUND: This retrospective study was conducted to know clinical and radiographic outcomes, complication rate, and survival of THA in patients with high hip dislocation secondary to developmental dysplasia(DDH) or septic arthritis of the hip(SSH). METHODS: Between March 2005 and September 2014, there were consecutive series of 53 THAs in patients with a highly dislocated hip secondary to DDH or SSH. Of these, 48 hips (DDH 24 and SSH 24) were reviewed at a mean follow-up of 7.9 years(range, 5.0-14.3 years). The mean age at the time of THA was 39.1 years(range, 18.0-59.0 years). RESULTS: Intraoperative blood loss, total drainage and blood transfusion amounts, and mean time to greater trochanter union were significantly lower in the DDH group than in the SSH group (P = .001, P = .039 and P = .014, and P = .015, respectively). No significant difference in Kaplan-Meier survivorship was observed between groups (log-rank, P = .343). The survival rates with an endpoint of cup aseptic loosening in cases with a cemented cup at 7.9 and 10 years (68.1% and 60.5%, respectively) were significantly lower than those in cementless cup cases (100%) at the same checkpoints (P = .019).. CONCLUSION: We found similar clinical outcomes between the DDH and SSH groups. However, due to poor bone quality and a lack of containment, cementless acetabular cups could not be performed in more than 50% of patients. Our experience shows that revision cementless fixation cup was possible due to reconstitution of the acetabulum in cases with failed cemented fixation.

3.
J Orthop Surg Res ; 15(1): 443, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993705

RESUMO

INTRODUCTION: Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. PATIENTS AND METHODS: This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. RESULTS: Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. CONCLUSIONS: Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

4.
Hip Pelvis ; 32(2): 99-104, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32566541

RESUMO

Purpose: To evaluate the incidence and presentation of osteoporotic sequential bilateral hip fractures (SBHF) in Center for Joint Disease, Chonnam National University Hwasun Hospital as there are limited studies with variable results reported in Korea. Materials and Methods: Records of 507 patients aged >60 years old presenting with osteoporotic hip fractures between 2009 and 2015 were retrospectively reviewed to document the occurrence and presentation of sequential hip fractures; mean post-treatment follow-up was 48 months. Additionally, any correlations between sequential fractures and initial fracture and risk factors were assessed. Bone mineral density (BMD) was measured before and after sequential hip fracture for comparison. Results: There were 246 femoral neck (Group A) and 261 intertrochanteric (Group B) fractures. The cumulative incidence of SBHF was 8.2% (42 patients total; 29 in Group A and 13 in Group B). Average interval of SBHF for Group A and Group B were 37.4 months and 29.9 months, respectively. There was significant correlation between the initial fracture type and sequential fractures, particularly the trochanteric and subgroup of those with neck fractures. Hypertension as a co-morbidity and female sex have been identified as risk factors for SBHF. No significant findings were noted regarding BMD and risk factors in both groups. Conclusion: The clinical presentations of SBHF noted here concur with other worldwide studies and may guide efforts to develop relevant programs to prevent SBHF.

5.
Acta Orthop Traumatol Turc ; 54(2): 217-220, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32254040

RESUMO

Nontyphoidal salmonella (NTS) infection can lead to gastroenteritis, enteric fever, and bacteremia. However, osteoarticular infections caused by NTS are rarely encountered. We report the case of a 53-year-old male patient with bilateral hip infection caused by NTS. We performed a two-stage reconstruction comprising debridement of both hip joints followed by prosthetic replacement with antibiotic-loaded acrylic cement because the patient's diagnosis was delayed for approximately three months and the hip joints were already damaged. At two-year follow-up, the clinical, radiologic, and laboratory findings were within the normal limits, and there was no sign of infection. This case is presented because reports of bilateral hip joint infection due to NTS are rare. Early detection and proper treatment are essential for the eradication of the infection. The use of a prosthesis made of antibiotic-loaded acrylic cement and prolonged antimicrobial therapy can be considered in the management of bilateral hip joint destruction due to delayed diagnosis of NTS infection.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa , Artroplastia de Quadril/métodos , Desbridamento/métodos , Diagnóstico Tardio , Articulação do Quadril , Infecções por Salmonella/tratamento farmacológico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Cimentos para Ossos/uso terapêutico , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella/isolamento & purificação , Resultado do Tratamento
6.
Hip Pelvis ; 32(1): 1-10, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32158723

RESUMO

The use of three-dimensional (3D) printing is becoming more common, including in the field of orthopaedic surgery. There are currently four primary clinical applications for 3D-printing in hip and pelvic surgeries: (i) 3D-printed anatomical models for planning and surgery simulation, (ii) patient-specific instruments (PSI), (iii) generation of prostheses with 3D-additive manufacturing, and (iv) custom 3D-printed prostheses. Simulation surgery using a 3D-printed bone model allows surgeons to develop better surgical approaches, test the feasibility of procedures and determine optimal location and size for a prosthesis. PSI will help inform accurate bone cuts and prosthesis placement during surgery. Using 3D-additive manufacturing, especially with a trabecular pattern, is possible to produce a prosthesis mechanically stable and biocompatible prosthesis capable of promoting osseointergration. Custom implants are useful in patients with massive acetabular bone loss or periacetabular malignant bone tumors as they may improve the fit between implants and patient-specific anatomy. 3D-printing technology can improve surgical efficiency, shorten operation times and reduce exposure to radiation. This technology also offers new potential for treating complex hip joint diseases. Orthopaedic surgeons should develop guidelines to outline the most effective uses of 3D-printing technology to maximize patient benefits.

8.
Arch Osteoporos ; 15(1): 3, 2019 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-31820121

RESUMO

The efficacy of once-weekly risedronate with and without cholecalciferol in bone mineral density (BMD) in Korean patients with osteoporosis was compared. After 12 months, both spine and hip BMD increased significantly in both groups, but there was no significant difference between two groups. INTRODUCTION: This study investigated the efficacy and safety of once-weekly risedronate with and without cholecalciferol in BMD in Korean patients with osteoporosis. METHODS: This was a prospective, 12-month, randomized, open-labeled, actively controlled trial involving 41 hospitals. A total of 841 subjects with osteoporosis were randomized to once-weekly risedronate (35 mg) and cholecalciferol (5600 IU) in a single pill (RSD+, n = 642) or once-weekly risedronate (35 mg) alone (RSD, n = 199). BMD was measured via dual-energy X-ray absorptiometry at the lumbar spine and hip, and the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), and alkaline phosphatase (ALP) were assayed at baseline and after 12 months of treatment. RESULTS: After 12 months, the lumbar spine, femoral neck, and total hip BMD increased significantly in both groups; there was no significant difference between two groups. Women in the RSD+ group exhibited significantly increased lumbar spine BMD, and subjects with previous fracture history in the RSD+ group had significantly increased total hip BMD compared with the RSD group. The serum 25(OH) D level increased significantly in the RSD+ group. The serum PTH level decreased in the RSD+ group but increased in the RSD group. The serum ALP level significantly decreased in both groups; there was no significant difference between two groups. CONCLUSIONS: A once-weekly pill containing risedronate and cholecalciferol had the equivalent antiresorptive efficacy on BMD compared with risedronate alone and improved 25(OH) D serum levels after 12 months of treatment without significant adverse events in Korean patients with osteoporosis.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Colecalciferol/administração & dosagem , Osteoporose/tratamento farmacológico , Ácido Risedrônico/administração & dosagem , Absorciometria de Fóton , Idoso , Fosfatase Alcalina/sangue , Densidade Óssea , Esquema de Medicação , Quimioterapia Combinada , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , República da Coreia , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue
9.
Indian J Orthop ; 53(5): 630-636, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31488932

RESUMO

Purpose: There are limited reports for the results of the fourth-generation ceramic-on-ceramic (CoC) articulation total hip arthroplasty (THA). And, throughout the surgical experience, we encountered some cases of liner pulling-out phenomenon after liner fixation and femoral preparation. The objective of this study was to evaluate the incidence, risk factors of delta ceramic liner or head fractures, and also the clinical and radiological results of using the fourth-generation CoC articulation in THA. Patients and Methods: We retrospectively reviewed 242 patients (263 hips) who underwent primary THA using the fourth-generation CoC articulation with a minimum followup of 2 years. Demographic data, Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient's satisfactory level were recorded. The radiological evaluation was used to evaluate the implant fixation and complications. Mean followup duration was 5.2 years. Results: Mean HHS and WOMAC score were significantly (P < 0.05) improved at the last followup. About 98.5% of the patients were satisfied with results of the surgery. All acetabular components were placed in adequate position and there was no osteolysis on acetabular or femoral components and subsidence of femoral stem. Four patients showed complications including one-liner fracture. Conclusion: Our midterm study demonstrated excellent clinical and radiological results with only one ceramic liner fracture. Moreover, the results of this study indicate that one possible cause of pulling-out phenomenon is the resonance effect during implantation in Dorr type A patients with the thick cortex. If the surgeon is aware of the liner malposition throughout the operation, the fourth-generation CoC articulation THA could be an outstanding treatment.

11.
J Orthop Sci ; 24(3): 452-457, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30415823

RESUMO

BACKGROUND: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure. METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing. RESULTS: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 µg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 µg/dl; p = 0.327) showed no significant difference. CONCLUSIONS: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.


Assuntos
Artroplastia de Quadril/instrumentação , Cerâmica , Prótese de Quadril , Próteses Articulares Metal-Metal , Fraturas Periprotéticas/cirurgia , Desenho de Prótese , Adulto , Idoso , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Falha de Prótese , Reoperação/instrumentação , Estudos Retrospectivos
12.
Biomater Res ; 22: 33, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30534414

RESUMO

Background: Total hip arthroplasty (THA) is probably one of the most successful surgical interventions performed in medicine. Through the revolution of hip arthroplasty by principles of low friction arthroplasty was introduced by Sir John Charnley in 1960s. Thereafter, new bearing materials, fixation methods, and new designs has been improved. The main concern regarding failure of THA has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. To resolve these problems, the materials of the modern THA were developed since then. Methods: A literature search strategy was conducted using various search terms in PUBMED. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'total hip arthroplasty', 'biomaterials', 'stainless steel', 'cobalt-chromium', 'titanium', 'polyethylene', and 'ceramic'. Results: The initial search retrieved 6921 articles. Thirty-two articles were selected and used in the review. Conclusion: This article introduces biomaterials used in THA and discusses various bearing materials in currentclinical use in THA as well as the newer biomaterials which may even further decrease wear and improve THA survivorship.

13.
Hip Pelvis ; 30(4): 254-259, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30534544

RESUMO

Purpose: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. Materials and Methods: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. Results: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0-5; P<0.05); HHS was 85 (range, 72-90); and mean bone union time was 5.0 (range, 2.0-8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27-14.63) mm; lateral average TAD was 7.26 (range, 1.20-18.43) mm; total average TAD was 14.21 (range, 2.47-28.66) mm; average lag screw sliding was 4.63 (range, 0-44.81) mm; and average angulation was varus 0.72°(range, -7.6°-12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5°. Conclusion: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

14.
Indian J Orthop ; 52(4): 369-373, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30078894

RESUMO

Background: Conversion from failed bipolar hemiarthroplasty (HA) to total hip arthroplasty (THA) presents a great challenge to orthopedic surgeons for bipolar head removal and cup placement with or without change of femoral stem. Conversion THA after failed bipolar arthroplasty is known to offer both symptomatic and functional improvement. This study evaluates the midterm functional outcome and complications, especially dislocation associated with femoral head diameter, after conversion THA. Materials and Methods: Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0-11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28-40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter. Results: Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013). Conclusions: Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.

15.
Hip Pelvis ; 30(2): 120-124, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29896462

RESUMO

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.

16.
J Orthop ; 15(2): 391-395, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29881161

RESUMO

Introduction: Negative culture findings are common in periprosthetic joint infection (PJI) of the hip. Methods: Retrospective study was performed to total 84 patients which devided into two groups: culture-negative (n: 27) and culture-positive (n: 57). Results: The reimplantation rate was 96.3% and 91.2% in the culture-negative and culture-positive groups, respectively. The overall infection control rate was 92.6% and 82.4% in the culture-negative and culture-positive groups, respectively. Conclusion: Two-stage revision resulted a comparable outcome for the treatment of culture-negative periprosthetic joint infection of the hip compared to the culture-positive group.

17.
Hip Int ; 28(5): 548-553, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29683001

RESUMO

INTRODUCTION: Patients with developmental dysplasia of the hip (DDH) present with a wide spectrum of deformities. Few studies have assessed the relationship between femoral anteversion (FA) and rotational profile. The aim of this study is to evaluate the influence of FA on the lower extremity rotational profile by comparing tibial torsion (TT) between the extremities on both sides in patients with unilateral DDH, using computed tomography (CT). PATIENTS AND METHODS: Thirty eight patients with unilateral developmental dysplasia of the hip, who underwent a preoperative rotational profile CT scan at our institution, were evaluated. 3D rotational profile CT was performed, and FA and TT of the extremities on both sides were measured. RESULTS: On individual comparison of the rotational profile, mean FA of the affected extremity showed a significantly higher value ( p = 0.006). But, there was no significant difference in mean TT between the 2 extremities. On group analysis, the excessive FA group (group B) showed significantly higher values of tibial torsion and tibial torsion side-to-side difference compared to the normal FA group (group A) ( p = 0.000, p = 0.011, respectively). CONCLUSIONS: Our study suggests that patients with DDH can present with excessive FA. Therefore, while treating patients who show excessive FA, surgeons must consider the possibility of a higher rotational profile of the affected extremity, before performing surgical treatments for DDH.


Assuntos
Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico , Articulação do Quadril/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tíbia/diagnóstico por imagem
18.
Acta Orthop Traumatol Turc ; 52(3): 216-221, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29598843

RESUMO

OBJECTIVE: Disparity in size between femoral head and acetabulum could promote premature degeneration of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease. PATIENTS AND METHODS: Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. There were 9 males and 5 females with a mean age of 29 years (range, 15-54 years). Functional and radiological results were reviewed at mean follow-up of 9 years (range, 4-12 years). RESULTS: Pain relief was obtained in 13 of 14 (92.8%) patients postoperatively. Good to excellent functional outcome was obtained in 10 of 14 (71.4%) patients. Mean Harris hip score was improved from 63 to 84 (p < 0.05) at the final follow-up. Improvement of limping gait was observed in 10 of 14 (71.4%) patients. Center edge angle improved from mean 24° (11-36°) preoperatively to mean 35° (27-46°) postoperatively (p < 0.05), acetabular angle improved from mean 43° (36-49°) preoperatively to mean 37° (32-44°) postoperatively (p < 0.05), acetabular head index improved from mean 69% (50-83%) preoperatively to mean 85% (73-100%) postoperatively (p < 0.05). Progression of arthrosis stage occurred in 3 of 14 (21%) patients. None of the hip with preoperative Stulberg III, 2 of 9 hips with Stulberg IV and 2 of 2 hips with Stulberg V needed conversion to total hip arthroplasty during the follow-up. CONCLUSION: Dome osteotomy of the pelvis combined with trochanteric advancement could give a reasonable treatment outcome for acetabular dysplasia due to Perthes' disease at mid to long-term follow-up. Advanced stage of arthrosis, preoperative Stulberg V and no improvement of limping gait after the surgery possibly associated with poor outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Acetábulo , Doenças do Desenvolvimento Ósseo , Doença de Legg-Calve-Perthes , Osteotomia , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Adulto , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/etiologia , Doenças do Desenvolvimento Ósseo/cirurgia , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Doença de Legg-Calve-Perthes/complicações , Doença de Legg-Calve-Perthes/cirurgia , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Pelve/cirurgia , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
Int Orthop ; 42(10): 2335-2341, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29478209

RESUMO

PURPOSE: The aim of this study was to evaluate the effectiveness of our technique on further collapse of the femoral head in Association Research Circulation Osseous (ARCO) stage II, patient's functional improvements, and analyze the survival rate of the affected hip. METHODS: Between June 2007 and March 2015, 24 hips diagnosed with osteonecrosis of the femoral head (ONFH) were treated with our muscle pedicle bone grafting (MPBG) technique using anterior one-third of gluteus medius attached to the greater trochanter. The group was consisted of 15 men and eight women, mean age of 36 years at the time of surgery. Mean follow-up was 6.2 years. RESULTS: Four hips showed regeneration, 11 hips showed no progression, and nine hips showed slight extent of the lesion. But during the follow-up, three hips underwent total hip arthroplasty at the mean follow-up of 5.8 years after the surgery. The survival rate at the last follow-up was approximately 87.5%. Excluding the three failed cases, the mean total Harris hip score was improved from 57.2 to 82.3 points (p < 0.05). We had no case of complications such as limping, numbness, wound infection, heterotopic ossification, nor intra- and post-operative fracture. CONCLUSION: We showed 87.5% of survival rate by average of 6.2-year follow-up, maximum of 10.1 years. And compared to other reports, our technique showed relatively good results. In the short term, our modified MPBG technique seems to be effective in ARCO stage II ONFH. We, therefore, suggest this technique as one of the promising treatments of choices for patients with ARCO stage II ONFH.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Cabeça do Fêmur/cirurgia , Músculo Esquelético/cirurgia , Adulto , Transplante Ósseo/efeitos adversos , Feminino , Seguimentos , Sobrevivência de Enxerto , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do Tratamento
20.
Stem Cell Res ; 26: 28-35, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29202447

RESUMO

A bone-remodeling imbalance induced by increased bone resorption and osteoclast formation causes skeletal diseases such as osteoporosis. Induction of osteogenic differentiation of bone marrow stromal cells (BMSCs) leads to bone regeneration. Many researchers have tried to develop new adjuvants as specific stimulators of bone regeneration for therapeutic use in patients with bone resorption. We tried to develop a new adjuvant that has stronger osteogenic differentiation-promoting activity than bone morphogenetic proteins (BMPs). In this study, we identified a new peptide, which we called bone-forming peptide (BFP)-3, derived from the immature precursor of BMP-7. Upon osteogenic differentiation, BMSCs treated with BFP-3 exhibited higher alkaline phosphatase (ALP) activity and mineralization ability and significantly up-regulated expression of osteogenic genes such as ALP, osteocalcin (OC), Osterix, and Runx2 compared with control BMSCs. Furthermore, fluorescence-activated cell sorting (FACS) and immunofluorescence analyses demonstrated that BFP-3 treatment up-regulated CD44 expression. Interestingly, extracellular signal-regulated kinase 1/2 (ERK1/2) and Smad1/5/8 phosphorylation was increased by BFP-3 treatment during osteogenic differentiation. Furthermore, BFP-3-induced osteogenic differentiation was significantly decreased by treatment with ERK1/2- and Smad-specific inhibitors. These results suggest that BFP-3 plays an important role in regulating osteogenic differentiation of BMSCs through increasing levels of osteogenic-inducing factors and regulating the ERK1/2 and Smad1/5/8 signaling pathways. Our finding indicates that BFP-3 may be a potential new therapeutic target for promoting bone formation.


Assuntos
Células da Medula Óssea/citologia , Proteína Morfogenética Óssea 7/metabolismo , Diferenciação Celular/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Células-Tronco Mesenquimais/citologia , Osteogênese/efeitos dos fármacos , Fragmentos de Peptídeos/farmacologia , Células da Medula Óssea/efeitos dos fármacos , Células da Medula Óssea/metabolismo , Células Cultivadas , Humanos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Proteína Quinase 1 Ativada por Mitógeno/genética , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/genética , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Transdução de Sinais/efeitos dos fármacos , Proteína Smad1/genética , Proteína Smad1/metabolismo , Proteína Smad5/genética , Proteína Smad5/metabolismo , Proteína Smad8/genética , Proteína Smad8/metabolismo
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