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1.
Bone Joint J ; 102-B(4): 414-422, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228075

RESUMO

AIMS: To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. METHODS: Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing. RESULTS: There were 61 revisions (9.7%; 0.82 revisions/100 observed component years, (OCYs)) in the all-cemented group and 18 (4.0%; 0.30/100 OCYs) in the hybrid group. The cumulative incidence of revision at 18 years was 12.1% for cemented and 5.2% for hybrids. There was a significantly greater risk of revision for all-cemented compared with hybrids (unadjusted sub-hazard ratio (SHR) 2.44; p = 0.001), and of revision for loosening, wear, or osteolysis (unadjusted SHR 3.77; p < 0.001). After adjustment, the increased risk of all-cause revision did not reach significance at age 70 years and above. The advantage for revision for loosening, wear, and osteolysis remained at all ages. CONCLUSION: This study supports the use of uncemented acetabular fixation when used in combination with the Exeter stem with improved survivorship for revision for aseptic loosening, wear, and osteolysis at all ages and for all-cause revision in patients less than 70 years. Cite this article: Bone Joint J 2020;102-B(4):414-422.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Cimentação/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos , Cimentação/efeitos adversos , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise/etiologia , Osteólise/cirurgia , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Falha de Prótese/etiologia , Sistema de Registros , Reoperação/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida
2.
Bone Joint J ; 102-B(4): 423-425, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228082

RESUMO

AIMS: Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a dual mobility cup (DMC) and compare this with our previous series using the posterior lip augmentation device (PLAD). METHODS: A retrospective review of patients treated with either a DMC or PLAD for dislocation in patients with a Charnley THA was performed. They were identified using electronic patient records (EPR). EPR data and radiographs were evaluated to determine operating time, length of stay, and the incidence of complications and recurrent dislocation postoperatively. RESULTS: A total of 28 patients underwent revision using a DMC for dislocation following Charnley THA between 2013 and 2017. The rate of recurrent dislocation and overall complications were compared with those of a previous series of 54 patients who underwent revision for dislocation using a PLAD, between 2007 and 2013. There was no statistically significant difference in the mean distribution of sex or age between the groups. The mean operating time was 71 mins (45 to 113) for DMCs and 43 mins (21 to 84) for PLADs (p = 0.001). There were no redislocations or revisions in the DMC group at a mean follow-up of 55 months (21 to 76), compared with our previous series of PLAD which had a redislocation rate of 16% (n = 9) and an overall revision rate of 25% (n = 14, p = 0.001) at a mean follow-up of 86 months (45 to 128). CONCLUSION: These results indicate that DMC outperforms PLAD as a treatment for dislocation in patients with a Charnley THA. This should therefore be the preferred form of treatment for these patients despite a slightly longer operating time. Work is currently ongoing to review outcomes of DMC over a longer follow-up period. PLAD should be used with caution in this patient group with preference given to acetabular revision to DMC. Cite this article: Bone Joint J 2020;102-B(4):423-425.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/instrumentação , Luxação do Quadril/cirurgia , Prótese de Quadril , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Registros Eletrônicos de Saúde , Feminino , Luxação do Quadril/etiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Desenho de Prótese , Falha de Prótese/etiologia , Reoperação/métodos , Estudos Retrospectivos
3.
Rev Med Liege ; 75(4): 243-248, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32267113

RESUMO

Hip arthroscopy is a technique that has been shown to be effective in the treatment of femoro-acetabular lesions. These are related either to an anomaly on the anterior aspect of the femoral neck ("cam effect") or an anomaly at the level of the acetabular margin ("pincer effect") or a combination of both. The main arthroscopic gesture for the cam conflict consists of a femoroplasty, i.e. a regularization of the anterior bone bump. Other gestures, such as reinsertion of the labrum and cartilage repair, can be contemplated during the same operation. In a pincer conflict, an acetabuloplasty associated with re-insertion of the labrum can be performed. Hip arthroscopy is a technique in progress in terms of the surgical technique as well as the number of skilled surgeons. It aims to slow down the osteoarthritic evolution of the hip joint in the context of femoro-acetabular conflicts. However, it remains a tech¬nique with a long learning curve and possible side effects or complications are not to be neglected.


Assuntos
Acetábulo , Artroscopia , Articulação do Quadril , Osteoartrite/cirurgia , Acetábulo/cirurgia , Artroscopia/métodos , Articulação do Quadril/cirurgia , Humanos
4.
Bone Joint J ; 102-B(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009433

RESUMO

AIMS: This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. METHODS: Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. RESULTS: Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. CONCLUSION: Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198-204.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Prótese de Quadril , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Reoperação
5.
Bone Joint J ; 102-B(2): 155-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009440

RESUMO

AIMS: Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. METHODS: We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). RESULTS: The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d'Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. CONCLUSION: The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155-161.


Assuntos
Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Idoso Fragilizado , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Comores , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suporte de Carga
6.
Medicine (Baltimore) ; 99(4): e18395, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977843

RESUMO

BACKGROUND: The purpose of this meta-analysis was to compare the efficacy of the modified Stoppa approach (MSA) and ilioinguinal approach (IA) in the treatment of anterior pelvic ring and acetabular fractures. METHODS: A literature search was conducted using PubMed, Embase, and Cochrane database for articles that compared MSA and IA in the treatment of anterior pelvic ring and acetabular fractures. All the included articles were evaluated by 2 trained reviewers in accordance with the Cochrane Collaboration Handbook for potential risk. The Jadad decision algorithm and Downs and Black scores were also used to assess the quality of the included studies. The extracted data included operative time, intraoperative blood loss, reduction quality, clinical outcome, and complications. RESULTS: Five articles were included in this meta-analysis, with 186 patients in the MSA group and 219 patients in the IA group. Compared with IA, MSA significantly shortened the operative time (P = .0002), decreased intraoperative blood loss (P = .002), and provided better reduction quality (P = .03). Meanwhile, this meta-analysis suggests no significant difference between MSA and IA regarding clinical outcomes (P = .63) and complications (P = .34). The subgroup analysis of complications also showed no statistically significant difference between the 2 groups (including infection, and vascular and nerve injuries). CONCLUSION: According to this meta-analysis, the currently available evidence suggests that MSA can significantly shorten operative time, decrease intraoperative blood loss, and provide better reduction quality than IA in the treatment of anterior pelvic ring and acetabular fractures. In addition, in terms of clinical outcomes and complications, no significant differences were found between the 2 groups. LEVEL OF EVIDENCE: Level IV, meta-analysis.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Perda Sanguínea Cirúrgica , Humanos , Duração da Cirurgia , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Complicações Pós-Operatórias/epidemiologia
7.
Orthop Clin North Am ; 51(1): 13-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739876

RESUMO

Open reduction and internal fixation of displaced acetabular fractures has been the gold standard for treatment of these complex injuries. The subset of older patients with dome impaction, femoral head impaction, or a posterior wall component are considered for treatment with concomitant open reduction and internal fixation and total hip arthroplasty. Little has been written on the surgical techniques to perform concomitant open reduction and internal fixation plus total hip arthroplasty safely. This article describes the important intrinsic factors for acetabular component stability, choice of surgical approach for management of these injuries, and surgical technique for anterior and posterior approaches.


Assuntos
Acetábulo/cirurgia , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Acetábulo/lesões , Idoso , Artroplastia de Quadril/métodos , Cadáver , Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Redução Aberta/normas , Cuidados Pós-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
8.
Niger J Clin Pract ; 22(12): 1728-1736, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793481

RESUMO

Background: Adult hip reconstruction following trauma and hip pathologies depends on a sound knowledge of the proximal femoral geometry (PFG), which varies from one ethnic population to another. Aim: The aim of the study, therefore, was to evaluate parameters of the proximal femoral geometry in Igbos of South Eastern Nigeria. Methodology: A 5-year review of normal X-rays of the pelvis showing both hips of patients' age 18-64 between 1 January 2012 to 31 December 2016 at Radiology Department of University of Nigeria Teaching Hospital Enugu was done. Results: There were 554 patients, 273 (49.3%) males and 281 (50.7%) females. The values of the head width established in this study showed there was a mean difference between the right and left proximal femurs, which was statistically significant (P < 0.05). There was statistical significant difference (P < 0.05) between the means of the parameters of the proximal femoral geometry when compared between gender, the only exception being the left medial cortical thicknes, which did not show any difference (P > 0.05). A comparison of means of PFG parameters of the Igbos and that of the Turkish population showed that there was statistically significant difference on both sides. Conclusion: Our study demonstrated that there was no difference in the means of both sides of femoral neck width and the intertrochanteric width of the left side. The correlations between PFG parameters showed that there was strong positive correlation that was significant apart from the right acetabular angle that did not correlate with other parameters.


Assuntos
Artroplastia de Quadril , Tíbia/anatomia & histologia , Acetábulo/cirurgia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Feminino , Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Tíbia/cirurgia
9.
Bone Joint J ; 101-B(12): 1557-1562, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786990

RESUMO

AIMS: The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. PATIENTS AND METHODS: A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). RESULTS: The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. CONCLUSION: The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557-1562.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Neoplasias Hematológicas/cirurgia , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Carcinoma/mortalidade , Carcinoma/secundário , Carcinoma/cirurgia , Feminino , Seguimentos , Neoplasias Hematológicas/mortalidade , Humanos , Linfoma/mortalidade , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
10.
Bone Joint J ; 101-B(12): 1578-1584, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31787002

RESUMO

AIMS: A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. PATIENTS AND METHODS: The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of 'borderline dysplastic hips' with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of 'borderline dysplastic hips' with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. RESULTS: The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (sd 9.1°)) compared with the unstable borderline group (mean 7.9° (sd 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. CONCLUSION: The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578-1584.


Assuntos
Acetábulo/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Epífises/diagnóstico por imagem , Epífises/fisiopatologia , Epífises/cirurgia , Feminino , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Seguimentos , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
11.
Chin Med J (Engl) ; 132(23): 2820-2826, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31856053

RESUMO

BACKGROUND: During cup implantation, vertical height of the cup center (V-HCC) should be precisely controlled to achieve sufficient bone-cup coverage (BCC). Our study aimed to investigate the acetabular bone stock and the quantitative relationship between V-HCC and BCC in Crowe types I to III hips. METHODS: From November 2013 to March 2016, pelvic models of 51 patients (61 hips) with hip dysplasia were retrospectively reconstructed using a computer software. Acetabular height and doom thickness were measured on the mid-acetabular coronal cross section. V-HCC was defined as the vertical distance of cup rotational center to the interteardrop line (ITL). In the cup implantation simulation, the cup was placed at the initial preset position, with a V-HCC of 15 mm, and moved proximally by 3-mm increments. At each level, the BCC was automatically calculated by computer. Analysis of variance and Kruskal-Wallis test were used to compare the differences between groups. RESULTS: There were no significant between-group differences in maximum thickness of the acetabular doom; however, peak bone stock values were obtained at heights of 41.63 ±â€Š5.14 mm (Crowe type I), 47.58 ±â€Š4.10 mm (Crowe type II), and 55.78 ±â€Š3.64 mm (Crowe type III) above the ITL. At 15 mm of V-HCC, median BCC was 78% (75-83%) (Crowe type I), 74% (66-71%) (Crowe type II), and 61% (57-68%) (Crowe type III). To achieve 80% of the BCC, the median V-HCC was 16.27 (15.00-16.93) mm, 18.19 (15.01-21.53) mm, and 24.13 (21.02-28.70) mm for Crowe types I, II, and III hips, respectively. CONCLUSION: During acetabular reconstruction, slightly superior placement with V-HCC <25 mm retained sufficient bone coverage in Crowe I to III hips.


Assuntos
Acetábulo/cirurgia , Simulação por Computador , Luxação Congênita de Quadril/cirurgia , Artroplastia de Quadril , Humanos , Estudos Retrospectivos
13.
Bone Joint J ; 101-B(11): 1459-1463, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674236

RESUMO

AIMS: Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for acetabular dysplasia. The purpose of this study was to investigate changes in muscle strength, gait speed, and clinical outcome in the operated hip after RAO over a one-year period using a standard protocol for rehabilitation. PATIENTS AND METHODS: A total of 57 patients underwent RAO for acetabular dysplasia. Changes in muscle strength of the operated hip, 10 m gait speed, Japanese Orthopaedic Association (JOA) hip score, and factors correlated with hip muscle strength after RAO were retrospectively analyzed. RESULTS: Three months postoperatively, the strength of the operated hip in flexion and abduction and gait speed had decreased from their preoperative levels. After six months, the strength of flexion and abduction had recovered to their preoperative level, as had gait speed. At one-year follow-up, significant improvements were seen in the strength of hip abduction and gait speed, but muscle strength in hip flexion remained at the preoperative level. The mean JOA score for hip function was 91.4 (51 to 100)) at one-year follow-up. Body mass index (BMI) showed a negative correlation with both strength of hip flexion (r = -0.4203) and abduction (r = -0.4589) one year after RAO. Although weak negative correlations were detected between strength of hip flexion one year after surgery and age (r = -0.2755) and centre-edge (CE) angle (r = -0.2989), no correlation was found between the strength of abduction and age and radiological evaluations of CE angle and acetabular roof obliquity (ARO). CONCLUSION: Hip muscle strength and gait speed had recovered to their preoperative levels six months after RAO. The clinical outcome at one year was excellent, although the strength of hip flexion did not improve to the same degree as that of hip abduction and gait speed. A higher BMI may result in poorer recovery of hip muscle strength after RAO. Radiologically, acetabular coverage did not affect the recovery of hip muscle strength at one year's follow-up. A more intensive rehabilitation programme may improve this. Cite this article: Bone Joint J 2019;101-B:1459-1463.


Assuntos
Acetábulo/cirurgia , Luxação do Quadril/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Osteotomia/métodos , Adulto , Feminino , Marcha/fisiologia , Luxação do Quadril/cirurgia , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/reabilitação , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento , Velocidade de Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto Jovem
14.
J Pediatr Orthop ; 39(10): 510-515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599860

RESUMO

BACKGROUND: Retroversion of the acetabulum is a cause of pincer impingement. Symptomatic retroversion has traditionally been treated with anteverting periacetabular osteotomy (PAO). However, arthroscopic rim trimming can also treat pincer impingement associated with acetabular retroversion. The purpose of this study was to report the outcomes and radiographic findings in a series of adolescent patients with symptomatic acetabular retroversion treated arthroscopically. METHODS: Data were prospectively gathered at a single institution using an established hip preservation registry. Patients below 18 years with a retroverted acetabulum that underwent primary hip arthroscopy with 2-year follow-up were included. Acetabular retroversion was defined by 3 radiographic criteria: the presence of crossover, ischial spine sign, and posterior wall sign. Radiographic measurements of the lateral center-edge angle, anterior center-edge angle, alpha angle, and crossover percentage were reported preoperatively and postoperatively. Patient-reported outcome (PROs) measures included the modified Harris Hip Score, the non-Arthritic Hip Score, Hip Outcome Score Sports Subscale, visual analog scale, and patient satisfaction, recorded at 3 months, 1 year, and 2 years, postoperatively. In addition, International Hip Outcome Tool scores were gathered at 2 years. RESULTS: Between April 2008 and July 2014, there were 43 patients (48 hips) treated with hip arthroscopy who met the inclusion criteria. The average age was 16.1 years (range, 13.9 to 17.9 y) and there were 38 females and 10 males. The average follow-up was 50.4 months, with a minimum of 2 years. Statistically significant improvements in all PROs were found at 2 years postoperatively. There were 9 hips with lateral center-edge angle ≤25 degrees; the PROs of this group was not different than patients with normal coverage. Three patients underwent arthroscopic revision. No patient subsequently underwent anteverting PAO during the study period. There were no reported complications. CONCLUSIONS: Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO. STUDY DESIGN: Level of evidence 4-case series.


Assuntos
Acetábulo/cirurgia , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Acetábulo/diagnóstico por imagem , Adolescente , Artroscopia/efeitos adversos , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etiologia , Seguimentos , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Radiografia , Reoperação , Resultado do Tratamento
15.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570349

RESUMO

A 21-year-old man underwent a joint-preserving posterior acetabular resection of metastatic osteosarcoma using a three-dimensional (3D) printed model and intraoperative navigation. The combined application of these advanced technologies can allow for surgical planning of osteotomies involving complex anatomy and help guide resections intraoperatively. They can maximise the achievement of negative oncological margins, preservation of native hip stability and critical neurovascular structures, and optimal postoperative function in an effort to resect all clinically evident disease. For this particular patient, with secondary bony metastases, they allowed for a safe and well-tolerated procedure that ultimately afforded him palliative benefit, improved quality of life and, conceivably, prolonged survival in the setting of a devastating prognosis. Although he, sadly, has since passed away, he survived for over 2 years after initial metastasis with preserved hip stability and the ability to graduate college, stay active and maintain a quality of life that addressed his goals of care.


Assuntos
Acetábulo/patologia , Neoplasias Ósseas/secundário , Osteossarcoma/secundário , Impressão Tridimensional/instrumentação , Cirurgia Assistida por Computador/métodos , Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Evolução Fatal , Humanos , Masculino , Margens de Excisão , Osteossarcoma/cirurgia , Osteotomia , Cuidados Paliativos , Qualidade de Vida , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Medicine (Baltimore) ; 98(36): e17029, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490390

RESUMO

There is an increased enthusiasm in treating osteolytic metastatic acetabulum via injecting polymethyl-methacrylate (PMMA) as a bone filler to provide pain relief and potential structural support. The aim of this respective study is to determine the function and quality of life improvement after cement acetabuloplasty.Thirty two patients underwent acetabular cement augmentation between May 2014 and March 2018 were respectively reviewed. Isolated percutaneous acetabuloplasty (PA) was performed in 15 patients (group A) while radiofrequency ablation with PA (RFA-PA) in 12 patients (group B). Together with PA, open reconstructive surgery on ipsilateral femur was performed in another 5 cases (group C). Pre- and posttreatment functional evaluation and quality of life (QoL) assessment were carried out.The average followup duration was 11.5 (range, 3-36) months. None of major complications occurred. 81.2% (26/32) of patients achieved complete pain relief. Reduction of pain intensity and improvement of functional status achieved significantly differences after treatment (P = .00). Significant improvement (P = .00) was observed in scales of global QoL and pain-related restrictions in daily activities. Both isolated PA and RFA-PA procedures were equally effective towards the improvement of function and quality of life (P > .05). Regarding 5 patients in group C, pain intensity decreased when loading the affected limb and they could walk with crutches or cane.Bone cement acetabuloplasty is an adequate and effective mini-invasive procedure to relieve pain, restore function, and enhance the quality of life of patients for as long as possible in metastatic patients with short life expectancy. Ipsilateral surgery appears to be safe and well tolerated.


Assuntos
Acetabuloplastia/métodos , Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Carcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Carcinoma/radioterapia , Carcinoma/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ablação por Radiofrequência , Recuperação de Função Fisiológica , Estudos Retrospectivos
17.
Clin Orthop Surg ; 11(3): 270-274, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475046

RESUMO

Background: The isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well fixed. In this study, the mid-term results of this procedure were evaluated retrospectively. Methods: Among the consecutive patients operated on from September 1995, two patients (three hips) were excluded because of inadequate follow-up, and the results of remaining 34 patients (34 hips) were evaluated. There were 20 men and 14 women with a mean age of 49 years. A conventional polyethylene liner was used in 26 cases and a highly cross-linked polyethylene liner was used in eight cases. In three cases, the liner was cemented in a metal shell because a compatible liner could not be used. Results: After a follow-up of 5 to 20.2 years, re-revision surgery was necessary in 10 cases (29.4%): in eight for wear and osteolysis at 55 to 101 months after liner exchange and in two for acetabular loosening at 1 and 1.5 years after liner exchange. Re-revision surgery included all component revision (four cases), cup revision (four cases), and liner exchange (two cases). In all re-revision cases, a conventional polyethylene liner was used initially. There was no failure in the cases in which a highly cross-linked polyethylene liner was used. Conclusions: The results of this study suggest that isolated acetabular liner exchange is a reasonable option for wear and osteolysis when the metal shell is well fixed. More promising long-term results are expected with the use of highly cross-linked polyethylene liners.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Prótese de Quadril/efeitos adversos , Osteólise/cirurgia , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Osteólise/etiologia , Polietileno , Desenho de Prótese , Falha de Prótese/etiologia , Reoperação , Estudos Retrospectivos , Adulto Jovem
18.
J Orthop Surg Res ; 14(1): 310, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514742

RESUMO

BACKGROUND: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. METHODS: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. RESULTS: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. CONCLUSIONS: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/patologia , Acetábulo/patologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/métodos , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Bone Joint J ; 101-B(9): 1042-1049, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474147

RESUMO

AIMS: Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty (THA) have been described. These are limited by low reproducibility, are less accurate than CT 3D reconstruction, and are cumbersome to use. These methods also partly rely on the identification of obscured radiological borders of the component. We propose two novel methods, the Area and Orthogonal methods, which have been designed to maximize use of readily identifiable points while maintaining the same trigonometric principles. PATIENTS AND METHODS: A retrospective study of plain radiographs was conducted on 160 hips of 141 patients who had undergone primary THA. We compared the reliability and accuracy of the Area and Orthogonal methods with two of the current leading methods: those of Widmer and Lewinnek, respectively. RESULTS: The 160 anteroposterior pelvis films revealed that the proposed Area method was statistically different from those described by Widmer and Lewinnek (p < 0.001 and p = 0.004, respectively). They gave the highest inter- and intraobserver reliability (0.992 and 0.998, respectively), and took less time (27.50 seconds (sd 3.19); p < 0.001) to complete. In addition, 21 available CT 3D reconstructions revealed the Area method achieved the highest Pearson's correlation coefficient (r = 0.956; p < 0.001) and least statistical difference (p = 0.704) from CT with a mean within 1° of CT-3D reconstruction between ranges of 1° to 30° of measured radiological anteversion. CONCLUSION: Our results support the proposed Area method to be the most reliable, accurate, and speedy. They did not support any statistical superiority of the proposed Orthogonal method to that of the Widmer or Lewinnek method. Cite this article: Bone Joint J 2019;101-B:1042-1049.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/efeitos adversos , Anteversão Óssea/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Acetábulo/cirurgia , Anteversão Óssea/etiologia , Diagnóstico por Computador , Cabeça do Fêmur/cirurgia , Humanos , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
BMC Cancer ; 19(1): 861, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470808

RESUMO

BACKGROUND: Our purpose was to examine the outcomes of patients who underwent extensive resection of periacetabular tumors involving the sacroiliac joint and joint reconstruction with a hemipelvic endoprosthesis. METHODS: The records of 25 consecutive patients diagnosed with Enneking type I/II/IV pelvic tumors from 2010 to 2016 who received resection and hemipelvic endoprosthesis reconstruction were retrospectively reviewed. RESULTS: The median follow-up period was 48 months. At the most recent follow-up, 11 patients were alive, with estimated 3- and 5-year survival rates of 45.6 and 38.0%, respectively. Fourteen patients died, with a mean survival of 20.8 months, and 8 patients had local recurrence at an average of 9.3 months after surgery. Distal metastases were detected in 11 patients at an average of 11.0 months after surgery. The total complication rate was 56.0%, and the most common complications were wound healing disturbances (28.0%) and deep infections (16.0%). The prosthesis-related complication rate was 24.0%; periprosthetic infections and aseptic loosening were most common. The estimated 1- and 3-year prosthesis survival rates were 81.2 and 63.2%, respectively. The mean Musculoskeletal Tumor Society score was 48.0%. Function and prosthesis-related complications did not differ significantly after adding an extra screw fixation to the first sacral vertebra. CONCLUSIONS: Reconstruction with the hemipelvic endoprosthesis described herein provides satisfactory function with a relatively low complication rate. Adding an extra screw fixation to the first sacral vertebra was not associated with any improvement in the clinical results after short-term follow-up. Improvement and further studies of this endoprosthesis are needed.


Assuntos
Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Implantação de Prótese/métodos , Articulação Sacroilíaca/cirurgia , Acetábulo/patologia , Adolescente , Adulto , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Infecções Relacionadas à Prótese/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Articulação Sacroilíaca/patologia , Resultado do Tratamento , Adulto Jovem
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