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1.
J Shoulder Elbow Surg ; 29(2): 340-346, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31952560

RESUMO

BACKGROUND: Post-traumatic elbow arthrofibrosis (PEA) and its associated limitations to elbow range of motion (ROM) are a recognized consequence of trauma to the pediatric elbow. Closed manipulation under anesthesia (CMUA) of the elbow can be performed in pediatric patients as a nonoperative attempt to improve dysfunctional ROM. Minimal outcome data to support CMUA exist. The study evaluates the efficacy of CMUA for PEA in pediatric patients. METHODS: Patients younger than 18 years who underwent CMUA (Current Procedural Terminology code 24300) for PEA between 2005 and 2015 at 3 institutions were included. A retrospective chart review was performed to collect demographic data and ROM premanipulation and at last follow-up. Paired 2-tailed t tests were used to compare pre- and postmanipulation elbow ROM. RESULTS: Thirteen patients with a mean age of 12.2 ± 2.6 years (range 6.7-15.6 years) met the inclusion criteria. Median time to CMUA from initial surgery was 4.2 months (interquartile range [IQR] 3.6-8.4, range 1.4-19.7 months). Median follow-up time was 6 months with an IQR of 3.3-10.0 months. At last follow-up, there was significant improvement in elbow flexion of 22° ± 17° (P < .001) and extension of 29° ± 21° (P < .001). The average premanipulation motion arc of 60° ± 24° significantly increased to 110° ± 22° at final assessment (P < .001). CONCLUSION: CMUA appears to be a valuable alternative and reliable procedure for improving PEA in pediatric patients who exhaust nonoperative interventions.


Assuntos
Articulação do Cotovelo/lesões , Fibrose/cirurgia , Artropatias/cirurgia , Adolescente , Anestesia , Criança , Estudos de Coortes , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Manipulação Ortopédica , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
2.
J Pediatr Orthop ; 40(2): 97-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923170

RESUMO

BACKGROUND: Pediatric osteoarticular infection can cause severe morbidity. Some infectious loci may be difficult to identify clinically, and there may be more than one. There is little agreement regarding the appropriate use of preoperative magnetic resonance imaging (MRI) in this setting. After noting an unacceptably high rate of unplanned returns to the operating room for recurrent infection, clinicians at a tertiary care children's hospital noticed many patients had adjacent foci of infection on postoperative MRI. As a result, patients experienced prolonged treatment courses and multiple surgeries. An interdisciplinary team instituted practice guidelines whereby all patients with suspected osteoarticular infection underwent MRI for planned debridement during a reserved morning slot with a surgical suite on hold to proceed directly to surgery if indicated. Images were reviewed in real time to form the surgical plan. Young patients that required sedation for MRI were taken to surgery under the same anesthetic used for MRI without being awakened. The purpose of our retrospective study is to determine if implementing the practice guidelines for acute management of osteoarticular infection reduced unplanned returns to the operating room. METHODS: A total of 93 patients with osteoarticular infection were included in this study. A total of 40 cases, group A, were treated before implementing practice guidelines; 53 cases, group B, were treated after implementing practice guidelines. Our primary outcomes of interest were the identification of adjacent infections prior to surgery and need for repeat surgery, either planned or unplanned. RESULTS: Implementation of these guidelines reduced repeat surgery from 50% of patients to <27% (P=0.0099). Of patients requiring repeat surgery, 85% (n=17) were unplanned in group A versus 60% (n=9) in group B (P=0.0099). Adjacent infections were identified in 47.5% (n=19) of patients in group A, versus 60% (n=32) in group B. Adjacent infections were known before surgery in 32% (n=6) of patients in group A versus 72% (n=23) in group B. There were no statistically significant differences in initial patient characteristics or sites of infection. CONCLUSIONS: Implementing these guidelines reduced the need for repeat surgery in this population. It is difficult to predict with sufficient accuracy which patients need preoperative MRI. While resource intensive, preoperative MRI appears to offer substantial benefit in preoperative planning.


Assuntos
Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Imagem por Ressonância Magnética , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Reoperação , Adolescente , Criança , Pré-Escolar , Desbridamento , Humanos , Lactente , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Estudos Retrospectivos
3.
Rev Port Cir Cardiotorac Vasc ; 26(3): 235-238, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734979

RESUMO

Synovial hemangioma is a rare nonneoplastic vascular malformation of the synovial membrane described by Bouchut in 1856. Fewer than 200 cases have been described in the literature, corresponding to 1% of all hemangiomas. The presenting symptoms are often non-specific, which often leads to a delay in diagnosis of many years and can result in arthropathy if left undetected. The early diagnosis of a synovial haemangioma is important as recurrent haemarthrosis may lead to irreversible joint damage and chronic inflammatory synovitis. In practice, there is no consensus on the best treatment of synovial hemangiomas in children. Total resection of the tumor can be performed by arthroscopy in localized forms and for small lesions. Open resection associated with synovectomy is necessary when the hemangioma occupies most of synovial membrane.


Assuntos
Hemangioma/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Membrana Sinovial/diagnóstico por imagem , Criança , Hemangioma/cirurgia , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Sinovectomia
4.
Khirurgiia (Mosk) ; (10): 55-61, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626240

RESUMO

OBJECTIVE: To assess mid-term and long-term results of metal-on-metal total hip arthroplasty. MATERIAL AND METHODS: There were 349 operations for the period 2006-2012 in our clinic. Sixty-four patients underwent a full examination. All patients underwent X-ray examination of the pelvis, MRI of hip joint with metal artifact reduction sequence (MARS). The concentration of cobalt and chromium metal ions was determined in blood serum. Each patient completed a questionnaire (Harris, Oxford, Womac, SF-36). 'Survival' of endoprostheses was calculated using the Kaplan-Meier method. RESULTS: According to the Oxford scale, 76.6% of patients had excellent clinical and functional outcomes, 10.9% - good, 9.4% - satisfactory, 3.1% - unsatisfactory. According to the Harris scale, 57.9% of patients had excellent results, 15.6% - good, 7.8% - satisfactory, 18.7% - unsatisfactory. Inclination less than 45 degrees was noted in 77.2% of acetabular components. It is optimal installation angle. According to MRI data, effusion was the main type of periprosthetic changes (16 cases). There were no periprosthetic changes in 33 cases. Pseudotumor was diagnosed in 5 cases. Mean concentrations of cobalt and chromium ions were 1.27 (13.57-0.12) and 0.59 (0.4-0.87) µg/l, respectively. Normal concentration of chromium ions was observed in all cases. Kaplan-Meier survival rate of endoprostheses was 89% (80-97%). CONCLUSION: There was no correlation between female sex, young age of patients and incidence of complications. It is necessary to exclude pseudotumor in case of pain syndrome and no signs of aseptic loosening of the components of the endoprosthesis.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/cirurgia , Artropatias/cirurgia , Próteses Articulares Metal-Metal , Cromo/sangue , Cobalto/sangue , Feminino , Prótese de Quadril , Humanos , Artropatias/sangue , Desenho de Prótese , Resultado do Tratamento
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1340-1344, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650745

RESUMO

Objective: To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. Methods: Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang's arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups ( P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement. Results: Median operation time of group A was 50.5 minutes ï¼»95%CI (49.3, 54.6)ï¼½, which was significantly shorter than that of group B ï¼»88.5 minutes, 95%CI (76.5, 92.8)ï¼½ (Z=-4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups ( t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ 2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The median subjective satisfaction score of group A was 2.0 ï¼»95%(1.4, 1.7)ï¼½, which was better than that of group B ï¼»2.0, 95%(1.6, 2.2)ï¼½ ( Z=-2.480, P=0.013). Conclusion: Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang's approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.


Assuntos
Artroscopia , Artropatias/cirurgia , Ligamentos Laterais do Tornozelo , Tornozelo , Articulação do Tornozelo , Humanos , Estudos Retrospectivos , Resultado do Tratamento
6.
Clin Orthop Surg ; 11(3): 258-264, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475044

RESUMO

There has been rapid evolution in new techniques and technology in shoulder arthroplasty. This has improved the efficiency of the procedures as well as expanded our ability to manage some of the most challenging cases. This article will review key aspects of patient evaluation, discuss key technical steps in primary anatomic and reverse arthroplasty, and lastly provide tips to facilitate revision surgery.


Assuntos
Artroplastia do Ombro/normas , Artropatias/diagnóstico , Artropatias/cirurgia , Lesões do Ombro/cirurgia , Artroplastia do Ombro/métodos , Humanos , Reoperação , Articulação do Ombro/cirurgia
7.
Blood Coagul Fibrinolysis ; 30(1S Suppl 1): S11-S13, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517710

RESUMO

: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within the context of a multidisciplinary team. Muscle hematomas must be diagnosed as early as possible and be subjected to continuous treatment until full resolution, as they are associated with the risk of severe complications (compartment syndromes and pseudotumors). Arthrocentesis (extraction of intra-articular blood) is recommended in cases of acute and profuse hemarthrosis. Synovectomy is mandatory in the case of synovitis. Radiosynovectomy plays a key role as it has been shown to reduce bleeding by 65%. Our department uses Yttrium-90 in knees and Rhenium-186 in elbows and ankles. Radiosynovectomy is our treatment of choice for synovitis whereas arthroscopic synovectomy is resorted to as second-line treatment. Total knee replacement (TKR) has shown itself to be effective for treating severe hemophilic arthropathy, although the infection risk in patients with hemophilia is higher than in patients with osteoarthritis (1-2 vs. 7%).


Assuntos
Hemofilia A/complicações , Artropatias/etiologia , Artropatias/cirurgia , Artroplastia do Joelho/métodos , Hemartrose/etiologia , Hemartrose/cirurgia , Humanos , Radioisótopos/uso terapêutico , Rênio/uso terapêutico , Sinovectomia/métodos , Sinovite/etiologia , Sinovite/cirurgia , Radioisótopos de Ítrio/uso terapêutico
8.
Iowa Orthop J ; 39(1): 63-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413676

RESUMO

Background: The primary indication for reverse shoulder arthroplasty (RSA) is rotator cuff arthropathy caused by a deficient rotator cuff. Cuff deficiency in patients is highly variable in its distribution and extent, with mechanical implications that may significantly affect post-operative recovery. This study investigated the effects of variable cuff deficiency on the propensity for impingement between the scapula and humeral component and resulting subluxation, the source of two common complications (scapular notching and instability). Methods: Five different finite element models of an RSA were analyzed with varying degrees of rotator cuff deficiency: (1) baseline, with intact subscapularis, infraspinatus and teres minor, (2) no subscapularis, (3) no subscapularis or infraspinatus, (4) no infraspinatus, and (5) no infraspinatus or teres minor. The supraspinatus was not included in any models, as it is absent in rotator cuff arthropathy. Each model was moved through a prescribed arc of 45° internal/ external rotation originating from neutral. Results: Greater rotator cuff deficiency was associated with more impingement and larger magnitudes of subluxation. The largest subluxation (7.5 mm) and highest impingement-related contact stress (479 MPa) was in the model lacking all rotator cuff muscle groups. Posterior subluxation was present in most models lacking the infraspinatus, while anterior subluxation was present in all models lacking the subscapularis. Conclusions: This study helps clarify how different rotator cuff deficiencies influence shoulder stability following RSA and can ultimately help predict which patients may be at greater risk for impingement-related scapular notching and subluxation. Clinical Relevance: Surgeons should carefully consider the nature of the rotator cuff deficiency and its influence on impingement and instability when planning for RSA.Level of Evidence: V.


Assuntos
Artroplastia do Ombro/métodos , Instabilidade Articular/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Lesões do Manguito Rotador/complicações , Síndrome de Colisão do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Artropatias/etiologia , Artropatias/cirurgia , Instabilidade Articular/fisiopatologia , Pontuação de Propensão , Medição de Risco , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia
9.
Z Orthop Unfall ; 157(4): 445-460, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31421652

RESUMO

Total hip arthroplasty (THA) represents a meticulously standardized procedure with highly satisfactory results for surgeons and patients alike. Anyhow, due to rare diseases, anatomic varieties or in posttraumatic situations, the restauration of a normal hip joint anatomy and physiological kinematics can become a big challenge for the treating surgeon. This article gives an overview of the variety of these challenging conditions (including developmental hip dysplasia, osteopetrosis, skeletal dysplasia, Paget's disease and extraarticular deformities) and with a selection of complex cases it should give the reader some thought-provoking impulses considering the management of complex primary THA cases. This includes with the choice of implant, intraoperative characteristics, certain pitfalls and postoperative considerations alike. As a result, it should minimize the risk for complications in these complex cases without minimizing the patient's expectations in a nearly normal hip function and painless movement.


Assuntos
Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Artropatias/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/normas , Articulação do Quadril/fisiopatologia , Humanos , Artropatias/fisiopatologia
10.
J Hand Surg Asian Pac Vol ; 24(3): 353-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438793

RESUMO

Background: Despite various treatment methods, complications are reported with ligament reconstruction for thumb carpometacarpal (CMC) arthropathy, such as proximal migration, dorsal subluxation of the first metacarpal base, and hyperextension of the first CMC joint. The flexor carpi radialis (FCR) tendon is, in some cases, too thin to maintain suspension on the first metacarpophalangeal (MCP) joint. We used one-half of the extensor carpi radialis longus (ECRL) tendon instead of the FCR tendon, and compared this method with conventional reconstruction using the FCR tendon. Methods: The procedures were performed during 12 thumb CMC arthropathies. One-half of the ECRL tendon was passed and then wrapped around the intact FCR tendon several times for 6 cases (ECRL group). One-half of the FCR tendon was passed for 6 cases (FCR group). On radiography, we compared the thumb to index finger metacarpal angle (M1M2) and the first MCP angle (P1M1) between groups. Grip strength, pinch strength, and DASH score were also evaluated up to 2 years post-surgery. Results: In the ECRL group, M1M2 and P1M1 1 year post-surgery showed significant improvements compared to those before surgery; they showed no significant difference in the FCR group, although they achieved a peak at 3 months post-surgery in both groups. Both groups showed improvements in other parameters from 3 months to 1 year post-surgery. Conclusions: Postoperative progression of hyperextension of the first CMC joint was significantly reduced in the ECRL group. The ECRL tendon is thicker than the FCR tendon. In addition, the insertion site of the ECRL tendon is at the dorsal side of the second metacarpal, and the tendon can extend from the dorsal side to the volar side to stabilize the first metacarpal. Thumb CMC arthroplasty using one-half of the ECRL tendon is a useful reconstruction method.


Assuntos
Artroplastia/métodos , Articulações Carpometacarpais , Artropatias/cirurgia , Tendões/cirurgia , Polegar , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço , Humanos , Masculino , Ossos Metacarpais/cirurgia , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-Idade , Radiografia
11.
Knee ; 26(5): 1010-1019, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402095

RESUMO

BACKGROUND: Determine whether the tibiofemoral motion and electromyographic activity of the knee differs in patients with a medial pivot implant, compared to those with cruciate-retaining and posterior-stabilised designs, during knee extension after Total Knee Arthroplasty (TKA). METHODS: An observational study was conducted on a cohort of patients that had undergone TKA for a minimum of 12 months prior. Three matched groups (n = 18) were categorised based on implant type: medial-pivot (MP), posterior-stabilised (PS) and cruciate-retaining (CR). Kinematics, with motion analysis (Vicon, USA) and surface electromyography (Delsys, USA) were assessed during step-ascent and walking tasks. RESULTS: All groups displayed a similar amount of knee extension in both tasks. They also paradoxically produced an average mean internal rotation movement during knee extension in both the step-ascent and walking tasks. The only significant difference was found in the step-ascent task, in which the MP group produced a larger absolute amount of rotation than the CR implant group (P = 0.007), but neither group differed from the PS implant group. The groups did not differ in rotation during the walking task (P > 0.05). The MP group displayed significantly (P < 0.01) greater knee extensor activation during the step-ascent than the PS group. CONCLUSION: The MP design was only significantly different to another implant design for the step-ascent task. Patients with either knee implant types were not strictly limited to producing the traditional "screw-home" mechanism, defined by external rotation during extension. Furthermore, comparison with the non-implant contralateral limb suggested that rotation is not necessarily dictated by implant design.


Assuntos
Artroplastia do Joelho/instrumentação , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Feminino , Fêmur/fisiopatologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Desenho de Prótese , Amplitude de Movimento Articular , Rotação , Tíbia/fisiopatologia , Tíbia/cirurgia , Caminhada
12.
Clin Podiatr Med Surg ; 36(4): 577-596, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466569

RESUMO

Evidence-based medicine continues to guide our treatment of patients. Owing to the unique characteristics of the first metatarsophalangeal joint (1st MTPJ) with its small surface area and the significant amount of multiplanar force that affects it, finding the perfect implant to allow motion and alleviate pain is still the ultimate goal. While some of the older metallic implants and silastic spacers may still be providing pain relief and function to patients, the majority have failed and caused significant bone loss along the way. The HemiCap implants have shown some promise in select patients and may still be a viable option in patients desiring maintenance of 1st MTPJ motion.


Assuntos
Artroplastia/instrumentação , Hallux , Artropatias/cirurgia , Articulação Metatarsofalângica , Próteses e Implantes , Humanos , Desenho de Prótese
13.
J Shoulder Elbow Surg ; 28(11): 2098-2102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31262638

RESUMO

BACKGROUND: There is currently no consensus regarding the safe timing interval between corticosteroid shoulder injections and future shoulder arthroscopies. Our study assessed the relationship between preoperative corticosteroid injection timing and shoulder arthroscopy infectious outcomes. METHODS: We used an insurance database to identify and sort all shoulder arthroscopy patients by corticosteroid shoulder injection history within 6 months before surgery. Patients who received injections were stratified by the timing of their most recent preoperative injection. The overall infection rate and rate of severe infections requiring treatment through intravenous antibiotics or surgical débridement in the 6-month postoperative period were compared using χ2 tests between the injection cohorts and a control group of patients defined as those with no injection history. RESULTS: We identified 50,478 shoulder arthroscopy patients, of whom 4115 received injections in the 6-month preoperative period. We found a significant increase in both the overall infection rate (P < .0001) and severe infection rate (P < .0001) in patients who received injections within 2 weeks before surgery (n = 79; 8.86% and 6.33%, respectively) compared with those who received no injections in the 6-month preoperative period (n = 46,363; 1.56% and 0.55%, respectively). No other significant differences were observed. CONCLUSIONS: Our results suggest that in patients who have received corticosteroid injections, shoulder arthroscopic procedures may be safely performed after at least 2 weeks has passed since the most recent injection to minimize the risk of postoperative infection. In addition, procedures performed within 2 weeks of an injection may increase the risk of postoperative infection.


Assuntos
Corticosteroides/administração & dosagem , Artroscopia/efeitos adversos , Artropatias/cirurgia , Articulação do Ombro , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Desbridamento , Esquema de Medicação , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade
14.
J Orthop Traumatol ; 20(1): 27, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31317280

RESUMO

The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too.


Assuntos
Artroplastia do Ombro/métodos , Artropatias/cirurgia , Articulação do Ombro/cirurgia , Cirurgia Assistida por Computador/métodos , Humanos , Articulação do Ombro/diagnóstico por imagem
15.
J Med Case Rep ; 13(1): 231, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311579

RESUMO

BACKGROUND: Synovial hemangioma of the knee is a rare benign tumor. Very rarely, the growth of bone is affected by long-term neglect of an intra-articular tumor. Our patient had not only various clinical symptoms but also dysplasia of the femoral bone. In this report, we aimed to raise awareness to prevent various disorders arising from an unnoticed or untreated hemangioma occurring within the knee joint. CASE PRESENTATION: Our patient was a 41-year-old Japanese man who had had occasional discomfort in the right knee since elementary school. Although he had undergone radiography at several hospitals since childhood, no issues were reported; subsequently, he consulted our hospital. We performed magnetic resonance imaging and discovered a mass. The mass was homogeneous with low intensity on T1-weighted sequences and high intensity on T2-weighted sequences adjacent to the medial femoral condyle. The shape of the medial femoral condyle presented with a concavity in axial images, with irregular margins from the patellofemoral joint to the medial femoral condyle. Moreover, by using magnetic resonance angiography, we discovered a second mass. We decided to perform open surgery to achieve complete excision. Histological examination indicated a synovial hemangioma involving a cavernous hemangioma and irregular arteriovenous connections originating from the subsynovial tissue. The patient became asymptomatic after surgery, with no recurrence for more than 4 years. CONCLUSIONS: Synovial hemangioma is rare and difficult to diagnose in outpatient examinations because radiography has a limited diagnostic capacity. Magnetic resonance imaging and angiography are very useful. Nontreatment of intra-articular hemangiomas may lead to dysplasia of the bone and various clinical symptoms. Early complete excision may be instituted to reduce these risks of hemarthrosis.


Assuntos
Hemangioma Cavernoso/patologia , Artropatias/patologia , Neoplasias de Tecidos Moles/patologia , Adulto , Diagnóstico Tardio , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Articulação do Joelho , Imagem por Ressonância Magnética , Masculino , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia
16.
J Bone Joint Surg Am ; 101(14): 1309-1318, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31318811

RESUMO

BACKGROUND: Localized-type tenosynovial giant cell tumor (TGCT) is a rare, neoplastic disease with only limited data supporting treatment protocols. We describe treatment protocols and evaluate their oncological outcome, complications, and functional results in a large multicenter cohort of patients. A secondary study aim was to identify factors associated with local recurrence after surgical treatment. METHODS: Patients with histologically proven localized TGCT of a large joint were included if they had been treated between 1990 and 2017 in 1 of 31 tertiary sarcoma centers. Of 941 patients with localized TGCT, 62% were female. The median age at initial treatment was 39 years, and the median duration of follow-up was 34 months. Sixty-seven percent of the tumors affected the knee, and the primary treatment at the tertiary center was 1-stage open resection in 73% of the patients. Proposed factors for predicting a first local recurrence after treatment in the tertiary center were tested in a univariate analysis, and those that demonstrated significance were subsequently included in a multivariate analysis. RESULTS: The localized TGCT recurred in 12% of all cases, with local-recurrence-free rates at 3, 5, and 10 years of 88%, 83%, and 79%, respectively. The strongest factor for predicting recurrent disease was a prior recurrence (p < 0.001). Surgical treatment decreased pain and swelling in 71% and 85% of the patients, respectively, and such treatment was associated with complications in 4% of the patients. Univariate and multivariate analyses of the patients who had not undergone therapy previously yielded positive associations between local recurrence and a tumor size of ≥5 cm versus <5 cm (hazard ratio [HR] = 2.50; 95% confidence interval [CI] = 1.32 to 4.74; p = 0.005). Arthroscopy (versus open surgery) was significantly associated with tumor recurrence in the univariate analysis (p = 0.04) but not in the multivariate analysis (p = 0.056). CONCLUSIONS: Factors associated with recurrence after resection of localized-type TGCT were larger tumor size and initial treatment with arthroscopy. Relatively low complication rates and good functional outcomes warrant an open approach with complete resection when possible to reduce recurrence rates in high-risk patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Artropatias/cirurgia , Sarcoma/cirurgia , Adulto , Artroscopia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Complicações Pós-Operatórias
17.
Medicine (Baltimore) ; 98(28): e16169, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305399

RESUMO

We aim to examine temporal trends of orthopedic operations and opioid-related hospital stays among seniors in the nation and states of Oregon and Washington where marijuana legalization was accepted earlier than any others.As aging society advances in the United States (U.S.), orthopedic operations and opioid-related hospital stays among seniors increase in the nation.A serial cross-sectional cohort study using the healthcare cost and utilization project fast stats from 2006 through 2015 measured annual rate per 100,000 populations of orthopedic operations by age groups (45-64 vs 65 and older) as well as annual rate per 100,000 populations of opioid-related hospital stays among 65 and older in the nation, Oregon and Washington states from 2008 through 2017. Orthopedic operations (knee arthroplasty, total or partial hip replacement, spinal fusion or laminectomy) and opioid-related hospital stays were measured. The compound annual growth rate (CAGR) was used to quantify temporal trends of orthopedic operations by age groups as well as opioid-related hospital stays and was tested by Rao-Scott correction of χ for categorical variables.The CAGR (4.06%) of orthopedic operations among age 65 and older increased (P < .001) unlike the unchanged rate among age 45 to 64. The CAGRs of opioid-related hospital stays among age 65 and older were upward trends among seniors in general (6.79%) and in Oregon (10.32%) and Washington (15.48%) in particular (all P < .001).Orthopedic operations and opioid-related hospital stays among seniors increased over time in the U.S. Marijuana legalization might have played a role of gateway drug to opioid among seniors.


Assuntos
Analgésicos Opioides/uso terapêutico , Controle de Medicamentos e Entorpecentes , Artropatias/tratamento farmacológico , Idoso , Estudos Transversais , Custos de Cuidados de Saúde , Hospitalização/tendências , Humanos , Artropatias/economia , Artropatias/cirurgia , Uso da Maconha/legislação & jurisprudência , Pessoa de Meia-Idade , Oregon , Procedimentos Ortopédicos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Washington
18.
Zhonghua Bing Li Xue Za Zhi ; 48(7): 510-514, 2019 Jul 08.
Artigo em Chinês | MEDLINE | ID: mdl-31288304

RESUMO

Objective: To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed. Methods: Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients' age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light. Results: The cohort included 62 females and 60 males. Patients' age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases; moderate (5-8): 101 cases; high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases; 1 grade:51 cases; 2 grade: 12 cases; 3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules; the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting. Conclusions: The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.


Assuntos
Artroplastia de Substituição , Artropatias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese
19.
Medicine (Baltimore) ; 98(23): e15745, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169673

RESUMO

RATIONALE: Valgus knees are relatively rare in the clinic. Treatments for valgus deviations >90° represent a surgical challenge to achieve a balance between the soft tissue and bone and prevent nerve damage. PATIENT CONCERNS: A 63-year-old woman with valgus deviations >90° in both knees complained that she had been unable to walk for 50 years. DIAGNOSES: Congenital malformation valgus deformity. INTERVENTIONS: Bilateral total knee arthroplasty (TKA) was performed using a rotating hinge knee instrument from Endo-Model for axial correction and stabilization of the joint. OUTCOMES: The patient fully recovered 3 months after surgery. At the follow-up 6 years after the operation, the function of the knee joint clearly improved. The knee society score (KSS) increased from 35 to 90. LESSONS: Constrained implants are commonly used to stabilize the joint and correct the bone axis in patients with severe ligamental instability, gross deformity, bone loss, and extreme deviation of the straight leg axis. Intraoperative exploration of the common peroneal nerve and the postoperative flexed position of the knee joints could help prevent nerve injuries.


Assuntos
Artroplastia do Joelho/métodos , Artropatias/cirurgia , Articulação do Joelho/anormalidades , Feminino , Humanos , Artropatias/congênito , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Amplitude de Movimento Articular
20.
BMC Musculoskelet Disord ; 20(1): 285, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31200682

RESUMO

BACKGROUND: Primary purpose of this study is to compare the clinical outcomes of patients undergoing arthroscopic arthrolysis in posttraumatic and non-traumatic elbow stiffness. Secondary aims are to compare the level of satisfaction and complications. METHODS: We retrospectively evaluated the patients undergoing arthroscopic elbow arthrolysis between January 2008 and September 2015 and have completed a minimum 2-year follow-up. Total of 141 patients (male = 90; female = 51) with 143 elbows (posttraumatic, n = 75; non-traumatic, n = 68) with an average age of 33 years were available for final evaluation. The average follow-up period was 44 months. We used the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), Visual Analogue Scale (VAS) to measure clinical outcomes. The level of satisfaction was measured by a self-constructed questionnaire. RESULTS: All parameters were significantly improved postoperatively (P < 0.01). However, statistically significant differences were not present in the rate of postoperative improvement of elbow ROM (P = 0.08) and MEPI (P = 0.21) in both groups. According to MEPI, 72(96%) elbows in posttraumatic and 60(88%) elbows in non-traumatic group were rated as good to excellent. No statistically significant differences were observed in the level of satisfaction (P = 0.76) and rate of complications (P = 0.91). CONCLUSIONS: Arthroscopic arthrolysis is an effective tool and a good option for the treatment of patients with posttraumatic and non-traumatic elbow stiffness. The rate of elbow ROM and MEPI score improvements were significant and comparable postoperatively with a high level of patient's satisfaction. However, postoperative rehabilitation is equally essential to maintain intraoperative elbow ROM, to attain optimal outcome and to prevent complications.


Assuntos
Artroscopia , Articulação do Cotovelo/cirurgia , Artropatias/cirurgia , Satisfação do Paciente , Adolescente , Adulto , Criança , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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