Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.660
Filtrar
1.
J Surg Orthop Adv ; 30(1): 50-54, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861195

RESUMO

The advent of computed tomography and development of three-dimensional (3-D) reconstructions has allowed for profound advances in the understanding of complex acetabular fractures. The authors sought to determine the impact of 3-D reconstructions on understanding of the morphology of these injuries. A survey of 20 fellowship-trained orthopaedic trauma surgeons was undertaken to assess the utility of these reconstructions on understanding three complex posterior acetabulum fractures. Respondents noted significantly better understanding of posterior wall and transverse-posterior wall fracture patterns compared to a posterior column-posterior wall pattern when utilizing two-dimensional imaging only. The respondent#x02019;s understanding of all three patterns was improved with the addition of 3-D reconstructions. With regards to individual images, posterior iliac oblique reconstructions obtained at 36-degree and 54-degree from posterior were reported to be most helpful in improving understanding of fracture morphology. Three-dimensional reconstructions of posterior acetabular fractures are effective in enhancing understanding of fracture morphology. (Journal of Surgical Orthopaedic Advances 30(1):050-054, 2021).


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X
2.
Bone Joint J ; 103-B(4): 795-803, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789467

RESUMO

AIMS: Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. METHODS: The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). RESULTS: The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). CONCLUSION: Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795-803.


Assuntos
Acetábulo/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Criança , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem
3.
Bone Joint J ; 103-B(4): 659-664, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789480

RESUMO

AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.


Assuntos
Acetábulo/cirurgia , Nervo Femoral/lesões , Osteotomia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
4.
Am J Sports Med ; 49(5): 1209-1219, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661717

RESUMO

BACKGROUND: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). PURPOSE: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. RESULTS: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P < .001). CONCLUSION: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.


Assuntos
Acetábulo , Luxação do Quadril , Acetábulo/cirurgia , Atividades Cotidianas , Estudos de Coortes , Feminino , Cabeça do Fêmur/cirurgia , Luxação do Quadril/cirurgia , Humanos , Osteotomia , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Resultado do Tratamento
5.
Clin Sports Med ; 40(2): 271-288, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673886

RESUMO

Acetabular dysplasia represents a structural pathomorphology associated with hip pain, instability, and osteoarthritis. The wide spectrum of dysplasia anatomically refers to a 3-dimensional volumetric- and surface area-based insufficiency in coverage and is classified based on the magnitude and location of undercoverage. Borderline dysplasia has been variably defined and leads to management challenges. In symptomatic dysplasia, treatment addresses coverage with periacetabular osteotomy. Concomitant simultaneous or staged hip arthroscopy has significant advantages to address intra-articular pathology. In nonarthritic individuals, there is evidence PAO alters the natural history of dysplasia and decreases the risk of hip arthritis and total hip arthroplasty.


Assuntos
Luxação do Quadril/cirurgia , Acetábulo/cirurgia , Adulto , Artralgia , Artroscopia , Feminino , Humanos , Masculino , Osteotomia , Resultado do Tratamento
6.
Bone Joint J ; 103-B(3): 492-499, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641418

RESUMO

AIMS: Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. METHODS: In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. RESULTS: Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). CONCLUSION: Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492-499.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril , Transplante Ósseo/métodos , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Espanha
7.
Orthopade ; 50(4): 287-295, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33751196

RESUMO

BACKGROUND: The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION: Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril , Procedimentos Cirúrgicos Reconstrutivos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia
8.
Acta Chir Orthop Traumatol Cech ; 88(1): 18-27, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764863

RESUMO

PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P < 0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P< 0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.


Assuntos
Impacto Femoroacetabular , Fraturas de Estresse , Acetábulo/cirurgia , Artroscopia , Feminino , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
9.
Acta Chir Orthop Traumatol Cech ; 88(1): 69-74, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764871

RESUMO

The authors report on three cases in which a custom-made 3D printed titanium acetabular component of total hip arthroplasty was used to manage an advanced acetabular bone defect with pelvic discontinuity. The implant surface structure impeded long-term bone integration. Nonetheless, the stable bridging of the acetabular defect resulted in full integration of impacted bone allografts at the base of the implant. The pelvic continuity was restored within 12 months after surgery, and thus the acetabulum was prepared for potential further implantation of a standard revision acetabular component. Only one of the three female patients underwent a revision surgery at 18 months after surgery, the other two female patients were satisfied to such a degree with the clinical outcome at 6 years and 5 years, respectively, after surgery that they refused to undertake the revision surgery, despite X-ray images showing signs of loosening of the custom-made titanium acetabular component. The authors concluded that the implantation technique of three-point fixed custom-made 3D printed acetabular component made of titanium combined with impaction grafting of the acetabular base is a good alternative in managing the advanced bone defects of acetabulum with pelvic discontinuity after the failure of total hip arthroplasty. Even though inadequate surface porosity of the thus produced component did not allow its permanent osteointegration, the assembly was stable enough to allow the bone allografts to rebuild and restore continuity of the pelvis and facilitated future implantation of the standard revision acetabular component. Key words: 3D printing, individual acetabular component, titanium, total hip prosthesis, revision hip arthroplasty, acetabular reconstruction, custom-made implants.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Feminino , Seguimentos , Humanos , Impressão Tridimensional , Desenho de Prótese , Falha de Prótese , Reoperação , Titânio , Resultado do Tratamento
10.
Zhongguo Gu Shang ; 34(3): 220-5, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787164

RESUMO

OBJECTIVE: To measure the maximum corridor parameters of the infra acetabular screw and evaluate the feasibility of screw insertion through digital analysis of the acetabular structure. METHODS: The pelvic CT data of 100 patients who received plain pelvic CT scan from April 2013 to June 2015 were retrospectively analyzed. There were 50 males, aged 20 to 84 years, with an average age of (48.42±17.48) years, and 50 females, aged 18 to 87 years, with an average age of (55.02±19.54) years. Patients with acetabular fractures, hip dysplasia, and metal implants in the acetabulum were excluded. Import CT data into Mimics software in DICOM format to generate a three-dimensional model, and find the axialprojection of the infra-acetabular corridor in the middle of the pubis ramus in the inlet view. A virtual screw was placed in the infra-acetabular space and measure the parameters including the diameter and the length of the maximum corridor, the distance from the insertion point to the pubic symphysis, to the anterosuperior iliac spine and to the medial edge of the pelvis. Then import the pelvic model into 3- matic software, establish the pelvic model anterior pelvic plane and median sagittal plane, and measure the angle between the screw axis and the two planes. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5 mm screw, and calculate the screw insertion rate. RESULTS: In 100 cases, 49% of patients had a infra acetabular corridor with a diameter ≥5 mm, and the rate of screw placement in men was significantly higher than that in women. The average diameter of the maximum corridor of infra-acetabular screw was (4.86±1.72) mm, the average length was (94.04±8.29) mm, the average distance from the insertion point to the pubic symphysis was (60.92±4.84) mm, to the anterosuperior iliac spine was (85.15± 6.85) mm, and to the medial edge of the pelvis was (6.12±3.32) mm. The mean angle between the axis of the screw and the median sagittal plane was (-1.38±4.74)°, and the mean angle between the axis of the screw and the anterior pelvic plane was (56.77±7.93)°. There are significant differences between male and female measured parameters, except for the angle between the screw axis and the anterior pelvic plane. There was no statistically significant difference in the maximum corridor parameters of infra-acetabular screw on both sides of the pelvis. CONCLUSION: This study shows that the insertion rate of infra-acetabular screws is low in local patients, and the feasibility of screw insertion should be fully evaluated before surgery.


Assuntos
Acetábulo , Parafusos Ósseos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
Bone Joint J ; 103-B(2): 299-304, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517728

RESUMO

AIMS: Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. METHODS: A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation. RESULTS: Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery. CONCLUSION: The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Colo do Fêmur/transplante , Luxação Congênita de Quadril/cirurgia , Adulto , Idoso , Artroplastia de Quadril/instrumentação , Cimentos para Ossos , Feminino , Seguimentos , Prótese de Quadril , Humanos , Pessoa de Meia-Idade , Transplante Autólogo , Resultado do Tratamento
12.
J Surg Oncol ; 123(5): 1316-1327, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33523514

RESUMO

Symptomatic peri-acetabular metastatic lesions are often treated with open surgery such as modified Harrington procedures. In an effort to avoid surgical complications inherently associated with open surgical approaches, we developed and recently reported a novel Tripod percutaneous screw technique. The tripod technique is minimally invasive and was found to yield excellent outcomes regarding both pain control and functionality. The procedure is performed in a standard operative theater using fluoroscopic guided percutaneous screws. Despite the simplicity of intraoperative set-up and instrumentation, it is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging for even an experienced orthopedic surgeon. The technique and bony conduits were previously described in the trauma literature, however, there are key points of difference in the setting of metastatic disease. Here we provide a compilation of a stepwise graphic guide for the tripod model in the setting of metastatic peri-acetabular lesions, as well as the tips and tricks based on our own experience. These encompass preoperative preparation, operating room settings, intraoperative fluoroscopic guidance, postoperative care, and subsequent conversion to a cemented total hip arthroplasty, if needed.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Neoplasias Ósseas/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Neoplasias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Ósseas/secundário , Fluoroscopia , Humanos , Neoplasias/patologia , Prognóstico
13.
J Arthroplasty ; 36(3): 1143-1148, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33616064

RESUMO

BACKGROUND: Templating is a critical part of preoperative planning for total hip arthroplasty (THA). The accuracy of templating on images acquired with EOS is unknown. This study sought to compare the accuracy and reproducibility of templating for THA using EOS imaging to conventional digital radiographs. METHODS: Forty-three consecutive primary unilateral THAs were retrospectively templated, six months postoperatively, using preoperative 2D EOS imaging and conventional radiographs. Two blinded observers templated each case for acetabular and femoral component size and femoral offset. The retrospectively templated sizes were compared to the sizes selected during surgery. Interobserver agreement was calculated, and the influence of demographic variables was explored. RESULTS: EOS templating predicted the exact acetabular and femoral size in 71% and 66% of cases, respectively, and to within one size in 98% of cases. The acetabular and femoral component size was more likely to be templated to the exact size using EOS compared to conventional imaging (P < .05). The femoral component offset choice was accurately predicted in 83% of EOS cases compared to 80% of conventional templates (P = .341). Component size and offset were not influenced by patient age, gender, laterality, or BMI. Interobserver agreement was excellent for acetabular (Cronbach's alpha = 0.94) and femoral (Cronbach's alpha = 0.96) component size. CONCLUSIONS: Preoperative templating for THA using EOS imaging is accurate, with an excellent interobserver agreement. EOS exposes patients to less radiation than traditional radiographs, and its three-dimensional applications should be explored as they may further enhance preoperative plans.


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
14.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542017

RESUMO

A 74-year-old patient presented to the emergency department with acute atraumatic hip pain 9 years after her primary left total hip arthroplasty (THA). Plain radiographic imaging demonstrated lateralisation of the femoral head within the acetabular shell-indicating an issue with the polyethylene liner. The patient required revision of the acetabular component and the femoral head, as well as a new polyethylene liner. A detailed analysis of the components removed was performed by DePuy Synthes Engineering. Between 2009 and 2020, 8 publications have documented 52 cases of liner dissociation with the Pinnacle acetabular component and Marathon polyethylene liner. Various theories have been proposed in the literature as all of these components appear to fail in the same way, with shearing of the locking tabs in the polyethylene liner. In spite of a manufacturer analysis of the components, no root cause was identified as to why the polyethylene liner failed.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Cabeça do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Polietileno/efeitos adversos , Falha de Prótese , Idoso , Feminino , Humanos , Radiografia , Reoperação
15.
Bone Joint J ; 103-B(2): 391-397, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517732

RESUMO

AIMS: Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction. METHODS: We reviewed 66 patients (45 males and 21 females) with a mean age of 53 years (24 to 81) who had undergone acetabular resection for chondrosarcoma. A total of 36 patients (54%) underwent acetabular reconstruction, most commonly with a saddle prosthesis (n = 13; 36%) or a tantalum total hip arthroplasty (THA) (n = 10; 28%). Mean follow-up was nine years (SD 4). RESULTS: There was no difference in the mean age (p = 0.63), sex (p = 0.110), tumour volume (p = 0.646), or type of resection carried out (p > 0.05) between patients with and without reconstruction. Of the original 66 patients, 61 (92%) were ambulant at final follow-up. There was no difference in the proportion of patients who could walk in the reconstruction and 'no reconstruction' groups (p = 0.649). There was no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients who were reconstructed and those who were not (61% vs 56%; p = 0.378). Patients with a tantalum THA had a significantly (p = 0.015) higher mean MSTS score (78%) than those who were reconstructed with a saddle prosthesis (47%) or who had not been reconstructed (56%). Patients who had undergone reconstruction were more likely to have complications (81% vs 53%; p = 0.033). CONCLUSION: Reconstruction after resection of the acetabulum is technically demanding. In selected cases, reconstruction is of benefit, especially when reconstruction is by tantalum THA; however, the follow-up for these patients remains mid-term. When not feasible, patients with no reconstruction have an acceptable functional outcome. Level of Evidence: Level III Therapeutic. Cite this article: Bone Joint J 2021;103-B(2):391-397.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Seguimentos , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Tantálio , Resultado do Tratamento
16.
Bone Joint J ; 103-B(2): 382-390, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517736

RESUMO

AIMS: There is an increased risk of dislocation of the hip after the resection of a periacetabular tumour and endoprosthetic reconstruction of the defect in the hemipelvis. The aim of this study was to determine the rate and timing of dislocation and to identify its risk factors. METHODS: To determine the dislocation rate, we conducted a retrospective single-institution study of 441 patients with a periacetabular tumour who had undergone a standard modular hemipelvic endoprosthetic reconstruction between 2003 and 2019. After excluding ineligible patients, 420 patients were enrolled. Patient-specific, resection-specific, and reconstruction-specific variables were studied using univariate and multivariate analyses. RESULTS: The dislocation rate was 9.3% (n = 41). Dislocation was most likely to occur in the first three months after surgery. Four independent risk factors were found, one of which was older age at operation (p = 0.039). The odds ratios (ORs) of those aged ≥ 60 years and 30 to 60 years were 8.50 and 4.64, respectively, compared with those aged < 30 years. The other three risk factors were resection of gluteus maximus (p = 0.010, OR = 5.8), vertical shift of the centre of rotation (COR) of the hip by ≥ 20 mm (p = 0.008, OR = 3.60), and a type I+II+III pelvic resection (p = 0.014, OR = 3.04). CONCLUSION: Hemipelvic endoprosthetic reconstruction after resection of a periacetabular tumour has a dislocation rate of 9.3% (n = 41). Patients are most likely to dislocate in the first three months after surgery. The risk is increased for older patients (especially those aged > 60 years) and for those with gluteus maximus resection, vertical shift of the COR ≥ 20 mm, and a type I+II+III pelvic resection. Cite this article: Bone Joint J 2021;103-B(2):382-390.


Assuntos
Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Articulação do Quadril/cirurgia , Luxações Articulares/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Tumor de Células Gigantes do Osso/cirurgia , Prótese de Quadril , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Fatores de Risco , Sarcoma/cirurgia , Resultado do Tratamento
17.
Int Orthop ; 45(4): 883-889, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33427896

RESUMO

PURPOSE: To present a novel surgical technique for the Bernese peri-acetabular osteotomy (PAO) using electromagnetic navigation (EMN) and patient-specific templates (PST), and to evaluate it against the traditional fluoroscopic technique. METHODS: We included 40 dysplastic hips. All PAOs were performed using PST and EMN. We recorded learning-related complications. For the purpose of acetabular fragment correction analysis, patients were divided into two groups. In the study group (EMN group, 30 hips), the acetabular fragment was reoriented with the help of EMN. In the control group (XR group, 10 hips), the acetabular fragment was reoriented using fluoroscopy. We compared the difference between the planned and achieved position of the acetabular fragment and outcomes between both groups. RESULTS: Two major complications occurred in four PAOs in the XR group only (first ten PAOs). The average absolute difference in planned and achieved lateral centre -edge angle (LCEA) and acetabular index (AI) was 1.2° ± 1.5° and 1.1° ± 2° for the EMN and 7° ± 6.1° and 6.3° ± 6.3° for the XR group (p = 0.02; p = 0.03). The average surgery duration was 183 ± 32 minutes for the EMN and 203 ± 42 minutes for the XR group (p = 0.19). At the last follow-up, the average Harris Hip Score (HHS) value was 88 ± 12 in the EMN and 86 ± 14 in the XR group (p = 0.84). CONCLUSIONS: Our study indicates that PAO performed with EMN and PST seems to be a safe and reproducible procedure with a short learning curve. Additionally, navigated reorientation of the acetabular fragment is significantly more accurate than the fluoroscopic technique.


Assuntos
Acetábulo , Luxação Congênita de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fluoroscopia , Humanos , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
18.
Int Orthop ; 45(3): 593-604, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33479835

RESUMO

BACKGROUND: Initial stability of uncemented acetabular components in total hip arthroplasty (THA) is important for osseointegration and potentially enhanced by screw fixation. We used Australian Orthopaedic Association National Joint Replacement Registry data to determine whether screw usage influences uncemented acetabular component survival. METHODS: Primary THA with uncemented acetabular components performed for osteoarthritis from 1999 to 2018 was included. Survivorship was calculated using Kaplan-Meier estimates of cumulative percent revision (CPR). Comparisons used Cox proportional hazards method. An instrumental variable analysis adjusted for surgeon preference for screws as a confounding factor was used. RESULTS: Three hundred thirty thousand one hundred ninety-two THAs were included (31.8% with screws, 68.2% without). Two hundred twenty thousand six hundred seven were included in the instrumental variable analysis. Revision rate of acetabular components (all causes) was higher with screws during the first six years (hazard ratio (HR) = 1.45 (95% CI 1.34, 1.57), p < 0.001) and lower thereafter (HR = 0.81 (95% CI 0.67, 0.98), p = 0.027). Revision rate of acetabular components for loosening was higher with screws over the entire study period (HR = 1.73 (95% CI 1.51, 1.98), p < 0.001). Overall THA revision rate was higher with screws during the first six years (HR = 1.20 (95% CI 1.15, 1.26), p < 0.001) but lower thereafter (HR = 0.89 (95% CI 0.81, 0.98), p = 0.020). Revision rate for dislocation was higher with screws over the entire period (HR = 1.16 (95% CI 1.06, 1.26), p < 0.001). Instrumental variable analysis revealed higher revision rates with acetabular screws in the first six years. (HR = 1.18 (95% CI 1.09-1.29), p < 0.001). CONCLUSION: Screws did not confer a protective effect against acetabular loosening and were not associated with long-term negative consequences.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Austrália/epidemiologia , Parafusos Ósseos , Humanos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Reoperação
20.
Sports Med Arthrosc Rev ; 29(1): 15-21, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395225

RESUMO

Borderline acetabular dysplasia represents a "transitional acetabular coverage" pattern between more classic acetabular dysplasia and normal acetabular coverage. Borderline dysplasia is typically defined as a lateral center-edge angle of 20 to 25 degrees. This definition of borderline dysplasia identifies a relatively narrow range of lateral acetabular coverage patterns, but anterior and posterior coverage patterns are highly variable and require careful assessment radiographically, in addition to other patient factors. Treatment decisions between isolated hip arthroscopy (addressing labral pathology, femoroacetabular impingement bony morphology, and capsular laxity) and periacetabular osteotomy (improving osseous joint stability; often combined with hip arthroscopy) remain challenging because the fundamental mechanical diagnosis (instability vs. femoroacetabular impingement) can be difficult to determine clinically. Treatment with either isolated hip arthroscopy or periacetabular osteotomy (with or without arthroscopy) appears to result in improvements in patient-reported outcomes in many patients, but with up to 40% with suboptimal outcomes. A patient-specific approach to decision-making that includes a comprehensive patient and imaging evaluation is likely required to achieve optimal outcomes.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Tomada de Decisão Clínica , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Artralgia/etiologia , Artroscopia , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Luxação do Quadril/complicações , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Osteotomia , Participação do Paciente , Medidas de Resultados Relatados pelo Paciente , Radiografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...