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1.
Medicine (Baltimore) ; 99(20): e20215, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443350

RESUMO

Hip preserving procedures are still a challenge in late-stage osteonecrosis of femoral head (ONFH) patients. We aimed to compare the clinical outcomes of surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy for treatment of ONFH in Association Research Circulation Osseous (ARCO) stage III patients.We retrospectively reviewed 30 ARCO stage III patients (33 hips) who had surgical dislocation and impaction bone graft or surgical dislocation and rotational osteotomy in our center from June 2012 to December 2017. Baseline characteristics, clinical evaluation using Harris score and radiologic evaluation up to 12 months after surgery were recorded and compared.Fifteen patients (17 hips) were in the surgical dislocation and impaction bone graft group and 15 patients (16 hips) were in the surgical dislocation and rotational osteotomy group. No significant differences in age, gender, etiology, ARCO stage, duration of illness, operation time, and length of hospitalization were observed between the 2 groups. Compared to preoperation Harris score, the Harris score of 6 months postoperation and 12 months postoperation significantly improved. At 12 months postoperation, the excellent and good rate was 76.5% in the impaction bone graft group and 87.5% in the rotational osteotomy group. No significant difference in Harris scores was detected in the 2 groups.Surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy had satisfactory 1-year efficacy for ARCO III ONFH patients. Surgical dislocation and rotational osteotomy had better short-term efficacy than surgical dislocation and impaction bone graft.


Assuntos
Necrose da Cabeça do Fêmur/cirurgia , Fratura-Luxação/cirurgia , Osteotomia/efeitos adversos , Adulto , Transplante Ósseo/métodos , Feminino , Cabeça do Fêmur/lesões , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
2.
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 , Regras de Decisão Clínica , 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
3.
BMC Musculoskelet Disord ; 20(1): 544, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730452

RESUMO

BACKGROUND: Several methods are available for the treatment of early-stage osteonecrosis of the femoral head. Core decompression with implantation is a widely-used treatment. However, no single implant is recognized as the most effective way to prevent disease progression. Silk has high strength and resiliency. This study explored the possibility of a strong and resilient silk protein biomaterial as a new alternative implant. METHODS: We investigated the biomechanical properties of the silk protein material by regular compression, torsion, and three-point bending tests. We established three-dimensional finite element models of different degrees of femoral head osteonecrosis following simple core decompression, fibula implantation, porous tantalum rod implantation, and silk protein rod implantation. Finally, we compared the differences in displacement and surface stress under load at the femoral head weight-bearing areas between these models. RESULTS: The elastic modulus and shear modulus of the silk protein material was 0.49GPa and 0.66GPa, respectively. Three-dimensional finite element analyses demonstrated less displacement and surface stress at the femoral head weight-bearing areas following silk protein rod implantation compared to simple core decompression (p < 0.05), regardless of the extent of osteonecrosis. No differences were noted in the surface deformation or surface stress of the femoral head weight-bearing areas following silk protein rod, fibula or tantalum rod implantation (p > 0.05). CONCLUSIONS: When compared with simple core decompression, silk protein rod implantation demonstrated less displacement and surface stress at the femoral head weight-bearing area, but more than fibula or tantalum rod implantation. Similar effects on the surface stress of the femoral head between the silk rod, fibula and tantalum rod implantations, combined with additional modifiable properties support the use of silk protein as a suitable biomaterial in osteonecrosis surgery.


Assuntos
Benzidamina/química , Descompressão Cirúrgica , Necrose da Cabeça do Fêmur/cirurgia , Cabeça do Fêmur/cirurgia , Proteínas de Insetos/química , Procedimentos Ortopédicos/instrumentação , Implantação de Prótese/instrumentação , Seda/química , Adulto , Fenômenos Biomecânicos , Força Compressiva , Módulo de Elasticidade , Análise de Falha de Equipamento , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/fisiopatologia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/fisiopatologia , Análise de Elementos Finitos , Humanos , Masculino , Teste de Materiais , Desenho de Prótese , Falha de Prótese , Estresse Mecânico , Propriedades de Superfície , Resistência à Tração
4.
BMC Musculoskelet Disord ; 20(1): 413, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488121

RESUMO

BACKGROUND: This study aimed to determine the influence of ageing on the incidence and site of femoral fractures in trauma patients, by taking the sex, body weight, and trauma mechanisms into account. METHODS: This retrospective study reviewed data from adult trauma patients aged ≥20 years who were admitted into a Level I trauma center, between January 1, 2009 and December 31, 2016. According to the femoral fracture locations, 3859 adult patients with 4011 fracture sites were grouped into five subgroups: proximal type A (n = 1359), proximal type B (n = 1487), proximal type C (n = 59), femoral shaft (n = 640), and distal femur (n = 466) groups. A multivariate logistic regression analysis was applied to identify independent effects of the univariate predictive variables on the occurrence of fracture at a specific site. A two-dimensional plot was presented visually with age and the propensity score accounts for the risk of a fracture at a specific femoral site. RESULTS: This analysis revealed that older age was an independent variable that could positively predict the occurrence of proximal type A (OR [95%CI]: 1.03 [1.03-1.04], p < 0.001) and B fractures (1.02 [1.01-1.02], p < 0.001), and negatively predict the occurrence of proximal type C (0.96 [0.94-0.98], p < 0.001), shaft (0.95 [0.95-0.96], p < 0.001), and distal fractures (0.98 [0.98-0.99], p < 0.001). DISCUSSION: Using the propensity scores which account for the risk of a fracture in a specific femoral site, this study revealed that the older patients were at a higher risk of developing proximal type A and type B fractures, while a lower risk of developing fractures in the shaft and distal femur. This incidence of fracture site can largely be explained by age-related factors, including a decrease in bone strength and falling being the most common mechanism of trauma in older patients. CONCLUSIONS: This study revealed a difference in the involvement of age in the incidence of femoral fracture sites in the trauma patients.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Envelhecimento/fisiologia , Fraturas do Fêmur/epidemiologia , Cabeça do Fêmur/lesões , Colo do Fêmur/lesões , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/fisiopatologia , Cabeça do Fêmur/fisiopatologia , Colo do Fêmur/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia/estatística & dados numéricos
5.
Surg Technol Int ; 35: 426-429, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282981

RESUMO

Alternative bearings allow for the increased utilization of large femoral heads in total hip arthroplasty. This study demonstrated the effect of increasing femoral head size on the force required for dislocation during intraoperative assessment. Using a standard posterior approach, 10 cadaver hips underwent total hip arthroplasty; components were implanted in a standard fashion. The extremity was attached to a custom jig to replicate intraoperative assessment (internal rotation with 90° of hip flexion/neutral adduction). This range of motion (ROM) was repeated in triplicate using femoral head sizes of 28mm, 32mm, 36mm, 40mm, and 44mm. The ROM to dislocation (degrees) and torque (N*m) required were recorded. With increasing head sizes, there was a significant increase in torque required for dislocation (p<0.0001). The least square means torques (N*m) for each femoral head size (28-44mm) were 2.07, 2.15, 2.42, 2.74, and 3.65N*m. The corresponding least square means ROMs prior to dislocation were 43.5°, 46.2°, 50.8°, 54.3°, and 59.5°. There was a significant difference in ROM between nonadjacent head sizes (i.e., 28mm and 44mm) (p<0.0001). Total hip implant stability is multifactorial. Increasing femoral head size may confer stability during intraoperative assessment by increasing both the ROM prior to dislocation and the force required for dislocation.


Assuntos
Artroplastia de Quadril , Cabeça do Fêmur/cirurgia , Luxação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , Cadáver , Cabeça do Fêmur/fisiopatologia , Luxação do Quadril/etiologia , Articulação do Quadril/fisiopatologia , Prótese de Quadril/efeitos adversos , Humanos , Desenho de Prótese , Amplitude de Movimento Articular , Torque
6.
Gait Posture ; 70: 336-340, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952106

RESUMO

BACKGROUND: Increased femoral anteversion (IFA) is defined as forwardly rotated femoral head relative to the transcondylar knee axis which may have a potential to reduce the functional quality of adolescents. Therefore, the aim of our study was to investigate the effects of IFA on lower-extremity function, falling frequency, and fatigue onset in neurologically intact children. RESEARCH QUESTION: Does increased femoral anteversion influence lower extremity function, falling frequency and fatigue on set in healthy children? METHODS: Sixty-five participants with increased femoral anteversion (IFA) and thirty-two healthy peers as control were included into the study. For the function, the lower extremity function form (LEFF) which is adapted from Lower Extremity Function Test used. Falling frequency and fatigue onset time were assessed by a Likert-type scale. In addition, the activities which cause frequently fall for the participants were questioned. RESULTS: Lower extremity function was found deteriorated (p= 0.02) and falling frequency was higher (p = 0.00) in IFA than in controls. Fatigue onset time was not different between groups, although lower extremity function was strongly correlated with fatigue onset (rho = -0.537, p < 0.001). IFA children fall four times more during running (60%), three times more during fast walking (21.42%) than their healthy peers (14.28%, 7.14% respectively). SIGNIFICANCE: IFA leads functional problems, especially in the form of high falling frequencies. According to the LEFF score, the most difficult functional parameters for these children were walking long distances, becoming tired, walking more than a mile, and standing on one spot. Also, shorter fatigue onset time may worsen the lower-extremity function secondarily. Because of the higher frequency of falling and functional problems, children with IFA may be more defenseless to injuries, especially in high-motor-skill activities such as running and soccer.


Assuntos
Acidentes por Quedas , Anteversão Óssea/fisiopatologia , Cabeça do Fêmur/fisiopatologia , Extremidade Inferior/fisiopatologia , Fadiga Muscular/fisiologia , Corrida/fisiologia , Caminhada/fisiologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Criança , Feminino , Voluntários Saudáveis , Humanos , Masculino
7.
Biomed Res Int ; 2019: 6021271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881992

RESUMO

Background and Purpose: The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods: We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results: Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion: The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.


Assuntos
Deficiências do Desenvolvimento/cirurgia , Cabeça do Fêmur/cirurgia , Luxação do Quadril/cirurgia , Osteotomia/métodos , Cartilagem/fisiopatologia , Cartilagem/cirurgia , Criança , Pré-Escolar , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Cabeça do Fêmur/fisiopatologia , Luxação do Quadril/fisiopatologia , Humanos , Lactente , Masculino , Pressão , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Bull Hosp Jt Dis (2013) ; 77(1): 53-56, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30865865

RESUMO

Legg-Calve-Perthes disease is a multifactorial process that can lead to debilitating femoral head deformity in children. Management can range from conservative (such as nonweightbearing protocols), bracing (such as A frames), to more invasive measures involving surgical interventions. First described by Axer in 1965, the varus derotational osteotomy (VDRO) has been a staple in the surgical management of Perthes disease. The goal of the VDRO is "containment" or prevention of extrusion of the head from the acetabulum. Many variations of the technique have been described over the years since its inception, but the most important factor in outcome is timing the intervention at the appropriate stage of Perthes disease to allow for maximum benefit. Through varusization of the neck shaft angle of the proximal femur, the VDRO has been shown to be a powerful tool in the management of those afflicted. As with any operative procedure, the VDRO can be associated with complications such as premature epiphyseal closure leading to shortened extremity, albeit very rare in occurrence. The VDRO is a mainstay in the treatment algorithm for Legg-Calve-Perthes disease and will continue to remain so in the future.


Assuntos
Cabeça do Fêmur/cirurgia , Doença de Legg-Calve-Perthes/cirurgia , Osteotomia/métodos , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/fisiopatologia , Humanos , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Doença de Legg-Calve-Perthes/fisiopatologia , Osteotomia/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
9.
J Pediatr Orthop ; 39(3): 119-124, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30730415

RESUMO

BACKGROUND: Factors including obesity and morphologic parameters around the hip that increase physeal stress are associated with an increased risk of slipped capital femoral epiphysis (SCFE). Recent evidence suggests that superior epiphyseal extension may confer stability to the physis and help protect against SCFE. The purpose of this study is to investigate the relationship between epiphyseal extension and SCFE using an age-matched and sex-matched cohort study. METHODS: We generated 2 separate cohorts for comparison: 89 patients with unilateral SCFE and 89 healthy subjects with no evidence of hip disease or deformity. We utilized the anterior-posterior and lateral films of the hip to measure the Southwick angle and the epiphyseal extension ratio (EER), defined as the ratio of extension of the capital femoral epiphysis down the femoral neck relative to the diameter of the femoral head. We then compared these measurements between cohorts and in subgroup analysis based on slip stability and whether subjects progressed to a contralateral slip. RESULTS: The SCFE cohort demonstrated a decreased superior epiphyseal extension ratio compared with control (superior EER 0.71 vs. 0.68, P=0.002). There was also a significant downward trend in superior EER from the control subjects (0.71±0.07) to the stable slips (0.69±0.06) to the unstable slips (0.65±0.04) with an overall difference between the groups (P=0.001). Eighteen of 44 (41%) subjects with unilateral stable slips and at least 6 months of follow-up went on to develop SCFE of the contralateral limb. The subjects who developed contralateral slips were younger (11.6±1.2 vs. 12.7±1.4 y, P=0.008); however, there was no difference in superior or anterior epiphyseal extension (P=0.75 and 0.23, respectively). There was no significant linear correlation between Southwick angle and superior or anterior EER (r=0.13 and 0.17, respectively, P>0.05 for both). CONCLUSIONS: Increasing capital femoral epiphyseal extension may confer physeal stability in the setting of SCFE. We propose that this epiphyseal extension reflects an adaptive response to limit physeal stress and reduce the risk for progression to SCFE. LEVEL OF EVIDENCE: Level III-prognostic study.


Assuntos
Cabeça do Fêmur , Colo do Fêmur , Lâmina de Crescimento , Articulação do Quadril , Escorregamento das Epífises Proximais do Fêmur/diagnóstico , Adolescente , Pesos e Medidas Corporais/métodos , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/fisiopatologia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/fisiopatologia , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Escorregamento das Epífises Proximais do Fêmur/etiologia , Escorregamento das Epífises Proximais do Fêmur/fisiopatologia
10.
Hip Int ; 29(4): 446-451, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30757914

RESUMO

INTRODUCTION: Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign). AIM: The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength. METHODS: The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial. RESULTS: The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69 p < 0.01). VAS of pain correlate significantly with coronal trunk angle on mid-stance of affected limb during gait (r = 0.761, p < 0.01). CONCLUSION: The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain.


Assuntos
Cabeça do Fêmur , Marcha , Osteoartrite do Quadril , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Fêmur , Cabeça do Fêmur/patologia , Cabeça do Fêmur/fisiopatologia , Marcha/fisiologia , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Osteoartrite do Quadril/fisiopatologia , Pelve , Tronco
11.
J Am Acad Orthop Surg ; 27(1): 12-22, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30475277

RESUMO

The hip has generally been considered an inherently stable joint. However, the femoral head moves relative to the acetabulum. Although the bones are primarily important in hip stability, the importance of the soft tissues has recently been demonstrated. Symptomatic microinstability of the hip is defined as extraphysiologic hip motion that causes pain with or without symptoms of hip joint unsteadiness and may be the result of bony deficiency and/or soft-tissue damage or loss. Recent work has helped improve the ability to identify microinstability patients preoperatively. Initial management begins with activity modification and strengthening of the periarticular musculature. Failing nonsurgical management, surgical intervention can be beneficial, focusing on treatment of the underlying cause of microinstability, as well as associated intra-articular pathology. Bony deficiency may be treated with a redirectional osteotomy, whereas those with adequate bony coverage may be treated with capsular plication, capsular reconstruction, and/or labral reconstruction.


Assuntos
Articulação do Quadril , Instabilidade Articular , Artralgia/etiologia , Artroscopia , Cabeça do Fêmur/fisiopatologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/terapia , Ligamentos Articulares/anatomia & histologia , Movimento , Força Muscular/fisiologia , Osteotomia
12.
Int Orthop ; 43(7): 1627-1634, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30039196

RESUMO

PURPOSE: To compare longitudinal growth and cam deformity of the proximal femur after treatment for slipped capital femoral epiphysis (SCFE) with one screw versus two smooth pins. METHODS: We studied 43 patients (29 males, 14 females; mean age, 12.1 years; range, 9.5-14 years) with idiopathic unilateral SCFE treated with in situ fixation with one cannulated screw (group A, n = 23) or two smooth pins (group B, n = 20). Anteroposterior and frog-leg radiographs of the pelvis were evaluated for each patient at initial presentation, post-operatively and at physeal closure. Longitudinal growth was evaluated using the femoral neck length (FNL), the caput-collum-diaphyseal (CCD) angle, and the articulo-trochanteric distance (ATD). Cam deformity was assessed using the anterior offset α-angle and the head-neck offset ratio (HNOR). The mean follow-up was 5.1 years (range, 4-7 years). RESULTS: Postoperatively, the mean CCD angle was 138.3°, the mean α-angle was 66.1° and the mean HNOR was - 0.030. At physeal closure, mean CCD angle significantly decreased to 133.6°, mean α-angle significantly reduced to 52.1°, and mean HNOR significantly improved to + 0.039. CCD, FNL, ATD, α-angle, and HNOR were not different between groups. CONCLUSIONS: One screw or two smooth pins result in similar longitudinal growth and deformity of the proximal femur after SCFE. The femoral head-neck junction remarkably improves until physeal closure; however, residual cam deformity is not avoided after in situ pinning. The complication rate with smooth pins is higher.


Assuntos
Fêmur/crescimento & desenvolvimento , Fêmur/fisiopatologia , Procedimentos Ortopédicos/instrumentação , Escorregamento das Epífises Proximais do Fêmur/fisiopatologia , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Adolescente , Pinos Ortopédicos/efeitos adversos , Parafusos Ósseos/efeitos adversos , Criança , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/crescimento & desenvolvimento , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/crescimento & desenvolvimento , Colo do Fêmur/fisiopatologia , Colo do Fêmur/cirurgia , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Período Pós-Operatório , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem
13.
PLoS One ; 13(12): e0208818, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30562353

RESUMO

Despite good clinical outcomes associated with curved intertrochanteric varus osteotomy for the treatment of osteonecrosis of the femoral head, post-operative leg-length discrepancy is frequently reported and might reduce patient satisfaction. Although previous report showed that varus angulation affected post-operative leg-length discrepancy, sufficient varus angulation is the most important factor for obtaining a lateral intact portion. Therefore, to ensure better postoperative outcomes, detection of other parameters associated with leg shortening may prove useful. This study aimed to detect other factors influencing post-operative leg-length discrepancy and to develop a theory for pre-operative planning. The study included 42 hips of 36 patients with osteonecrosis of the femoral head [25 men and 11 women; mean age at the time of surgery, 33.8 years (range, 17 to 53 years)]. Patients were assessed their clinical and radiological results bofore and after surgery. Additionally, a mathematical model was developed to predict leg shortening after curved intertrochanteric varus osteotomy based on the degree of varus angulation and the distance between the femoral head and osteotomy arc centers. Predicted and actual leg shortening in patients were compared to verify the accuracy of our model. Post-operatively, mean varus angle was 21.7° (range, 15 to 38°) and mean leg shortening was 1.7 mm (range, -5.1 to 11.4 mm). Univariate analysis showed that varus angulation and lateral shift of the osteotomy arc might influence the degree of leg shortening. Furthermore, mathematically predicted leg shortening significantly correlated with actual leg shortening (r = 0.905, p < 0.001), suggesting the usefulness of our model for predicting complications of curved intertrochanteric varus osteotomy. This study indicates the importance of not positioning the center of the osteotomy arc lateral from the center of the femoral head to minimize leg shortening after curved intertrochanteric osteotomy.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Perna (Membro) , Modelos Biológicos , Osteotomia , Adolescente , Adulto , Feminino , Cabeça do Fêmur/patologia , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/fisiopatologia , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Perna (Membro)/fisiologia , Perna (Membro)/fisiopatologia , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
14.
Biomed Mater Eng ; 29(6): 723-737, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282330

RESUMO

The selection of best material pair in the hip prosthetics design for improved performance and life relies on the estimation of hip joint contact stresses and contact pressure distribution during various dynamic loading cycles: Climbing Upstairs, Climbing downstairs and Knee bending. The maximum Von Mises stress, contact pressure and deformation are considered factors in selecting the material pair in this current study. This is done by analysis of a three-dimensional finite element model of the acetabular component during the different dynamics cycles using ANSYS®. The different material combination of bearing couples considered for this analysis are metal in contact with plastic, metal on metal, metal on ceramic, ceramic on plastic, ceramic on metal and ceramic on ceramic. The numerical results were validated by comparing them with the FEA results of Hai-Bo Jiang et al. for the existing material combinations and a high correlation of 92% was observed. We found that the Alumina femoral head paired with ultra-high molecular weight polyethylene (UHMWPE) cup reduces the maximum Von Mises stress and maximum contact pressure developed at the interface amongst other material pairs.


Assuntos
Articulação do Quadril/fisiopatologia , Prótese de Quadril , Desenho de Prótese , Fenômenos Biomecânicos , Cerâmica , Elasticidade , Cabeça do Fêmur/fisiopatologia , Análise de Elementos Finitos , Humanos , Teste de Materiais , Metais/química , Movimento (Física) , Plásticos/química , Polietilenos/química , Pressão , Estresse Mecânico , Suporte de Carga
15.
Biomaterials ; 187: 39-46, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30292940

RESUMO

Osteonecrosis of the femoral head (ONFH) is a debilitating disease that may progress to femoral head collapse and subsequently, degenerative arthritis. Although injection of bone marrow-derived mononuclear cells (BMMCs) is often performed with core decompression (CD) in the early stage of ONFH, these treatments are not always effective in prevention of disease progression and femoral head collapse. We previously described a novel 3D printed, customized functionally-graded scaffold (FGS) that improved bone growth in the femoral head after CD in a normal healthy rabbit, by providing structural and mechanical guidance. The present study demonstrates similar results of the FGS in a rabbit steroid-induced osteonecrosis model. Furthermore, the injection of BMMCs into the CD decreased the osteonecrotic area in the femoral head. Thus, the combination of FGS and BMMC provides a new therapy modality that may improve the outcome of CD for early stage of ONFH by providing both enhanced biological and biomechanical cues to promote bone regeneration in the osteonecrotic area.


Assuntos
Transplante de Medula Óssea , Necrose da Cabeça do Fêmur/terapia , Cabeça do Fêmur/fisiopatologia , Tecidos Suporte/química , Animais , Desenvolvimento Ósseo , Fosfatos de Cálcio/química , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/fisiopatologia , Masculino , Acetato de Metilprednilosona , Poliésteres/química , Porosidade , Impressão Tridimensional , Coelhos , Propriedades de Superfície , Distribuição Tecidual , Engenharia Tecidual/métodos
16.
Clin Orthop Relat Res ; 476(11): 2157-2166, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30179949

RESUMO

BACKGROUND: Patients with comparable severities of developmental dysplasia of the hip (DDH) may variably progress to osteoarthritis (OA) over time. Although joint congruency may be associated with OA progression in patients with DDH, it has only been assessed subjectively. We assessed the gap between the rotational centers of the acetabulum and femoral head (center gap) as a possible predictive measure of OA progression in patients with DDH. QUESTIONS/PURPOSES: In patients with bilateral DDH, we asked: (1) What is the probability of OA progression (Tönnis grade) or symptom development (pain) in the asymptomatic contralateral hip of patients with DDH undergoing unilateral joint-preserving surgery? (2) Is the center gap measurement associated with OA progression or symptom development in these hips? (3) Is the center gap measurement correlated with previous radiographic parameters? METHODS: A total of 297 patients (319 hips) underwent unilateral eccentric rotational acetabular osteotomy at our institution between July 1989 and December 1999. We performed no other joint-preserving surgery to treat patients with DDH during this timeframe. The inclusion criteria for the study were patients younger than 55 years of age, the contralateral hip classified as Tönnis Grade 0, no previous surgical interventions, and asymptomatic at the time of eccentric rotational acetabular osteotomy (155 patients, 155 hips). The exclusion criteria were a contralateral hip without dysplasia (four patients, four hips), loss to followup before 10 years (42 patients, 42 hips [27%]), or missing medical records or radiographs (21 patients, 21 hips [14%]). The remaining 88 patients (88 hips; 11 males and 77 females) with a mean age of 39 years (range, 17-53 years) and mean followup of 20 years (range, 10-27 years) were analyzed. From the institutional database, radiographic parameters including the center gap in the AP view were assessed using radiographs at the time of eccentric rotational acetabular osteotomy, and the Tönnis grade was recorded 1 year postoperatively and annually thereafter retrospectively. We defined migration of the rotational center of the femoral head based on the rotational center of the acetabulum in the horizontal plane as center gap X (mm) and in the vertical plane as center gap Y (mm) and defined the absolute value between the centers as center gap distance (mm). Using κ statistics, intra- and interobserver reliabilities were determined to be 0.896 and 0.857 for center gap X, 0.912 and 0.874 for center gap Y, and 0.912 and 0.901 for the center gap distance, respectively. When patients reported any contralateral ipsilateral hip pain during clinic visits, the hip was considered symptomatic. Kaplan-Meier survivorship analyses were performed with OA progression or symptom development in the nonoperative hip as the endpoint. Multivariate analyses were performed to assess risk factors for each outcome using the Cox proportional hazards model. Correlation analyses between the center gap and other parameters including lateral center-edge angle, femoral head extrusion index, acetabular depth-to-width index, femoral head lateralization, minimum width of the joint space, head sphericity, and joint congruency were performed using Pearson's correlation coefficient. RESULTS: At 20 years postoperatively, the probability of OA progression in the nonoperative hip was 13% (95% confidence interval [CI], 7.1-22.1) and the probability of symptom development was 34% (95% CI, 24.7-46.1). The center gap X measurements in the groups with OA progression (lateral 2.0 ± 2.1 [SD] mm) or symptom development (lateral 0.9 ± 2.4 mm) took a more lateral direction than those in the group without OA progression (medial 0.4 ± 2.1 mm) or symptom development (medial 0.5 ± 2.0 mm) (OA progression, p < 0.001; symptom development, p = 0.005). The center gap Y measurements in the groups with OA progression (distal 2.7 ± 7.1 mm) or symptom development (distal 2.1 ± 6.0 mm) took a more distal direction than those in the group without OA progression (proximal 1.6 ± 6.2 mm) or symptom development (proximal 2.5 ± 6.1 mm) (OA progression, p = 0.027; symptom development, p = 0.001). Independent risk factors for OA progression were the femoral head extrusion index (hazard ratio [HR], 1.11; 95% CI, 1.01-1.22; p = 0.028) and the center gap X (HR, 1.52; 95% CI, 1.07-2.16; p = 0.019), whereas no independent risk factors for symptom development were found. The center gap in the horizontal plane had no correlations with any other radiographic parameter studied. CONCLUSIONS: The center gap in the horizontal plane had a modest association with OA progression in this group of patients with DDH. Future studies are needed to determine the normal value of the center gap for patients without DDH and to assess the center gap in lateral radiographic views. LEVEL OF EVIDENCE: Level IV, prognostic study.


Assuntos
Acetábulo/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Acetábulo/anormalidades , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Pontos de Referência Anatômicos , Bases de Dados Factuais , Progressão da Doença , Feminino , Cabeça do Fêmur/anormalidades , Cabeça do Fêmur/fisiopatologia , Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/fisiopatologia , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/anormalidades , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/fisiopatologia , Osteotomia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Ned Tijdschr Geneeskd ; 1622018 Jul 20.
Artigo em Holandês | MEDLINE | ID: mdl-30182636

RESUMO

Although cycling has positive health effects, including improvement of cardiovascular fitness, it does not have a favourable effect on bone health. In professional cyclists, the bone mineral density (BMD) will actually have decreased at the end of an intensive season. As a professional cyclist's career progresses, there will be a further decrease in BMD particularly in the hip and lumbar spine. The forward leaning position, the repetitive movement at low intensity, and the fact that body weight is carried by the bicycle all contribute to non-stimulation of bone formation. The cyclists' low body weight, which is desirable for climbers in particular, and possibly their dietary pattern may exacerbate this negative effect. To reduce the risk of fractures both during and after a cycling career, it is desirable that more attention is paid to strengthening of the bones. The effectiveness of training programmes to strengthen the bones should be investigated in carefully designed research studies.


Assuntos
Ciclismo/fisiologia , Densidade Óssea , Peso Corporal , Dieta , Cabeça do Fêmur/fisiopatologia , Colo do Fêmur/fisiopatologia , Fraturas Ósseas/prevenção & controle , Humanos , Vértebras Lombares/fisiopatologia , Magreza/fisiopatologia
18.
J Orthop Surg Res ; 13(1): 187, 2018 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-30055642

RESUMO

BACKGROUND: Although a raised intraosseous pressure (IOP) has been found in osteoarthritis and osteonecrosis, the normal physiology of subchondral circulation is poorly understood. We developed an animal model and explored the physiology of normal subchondral perfusion and IOP. METHODS: In 21 anaesthetised rabbits, 44 intraosseous needles were placed in the subchondral bone of the femoral head (n = 6), femoral condyle (n = 7) or proximal tibia (n = 31). Needles were connected to pressure transducers and a chart recorder. In 14 subjects, the proximal femoral artery and vein were clamped alternately. In five subjects, arterial pressure was measured simultaneously in the opposite femoral artery. RESULTS: The average IOP at all 44 sites was 24.5 mmHg with variability within SD 6.8 and between subjects SD 11.5. IOP was not significantly influenced by gender, weight, site or size of a needle. Needle clearance by flushing caused a prolonged drop in IOP whereas after clearance by aspiration, recovery was rapid. IOP recordings exhibited wave patterns synchronous with the arterial pulse, with respiration and with drug circulation time. There was a correlation between IOP and blood pressure (13 sites in 5 subjects, Pearson correlation 0.829, p < 0.0005). There was a correlation between IOP and the associated pulse pressure (PP) in 44 sites among 21 subjects (Pearson correlation 0.788, p < 0.001). In 14 subjects (31 sites), arterial occlusion caused a significant reduction in IOP and loss of PP (p < 0.0001). Venous occlusion significantly raised IOP with preservation of the PP (p < 0.012). CONCLUSION: Our study shows that subchondral cancellous bone behaves as a perfused tissue and that IOP is mainly a reflection of arterial supply. A single measure of IOP is variable and reflects only perfusion at the needle tip rather than being a measure of venous back pressure. Alternate proximal vessel clamping offers a new means of exploring the physiology of subchondral perfusion. We describe a model that will allow further study of IOP such as during loading.


Assuntos
Cabeça do Fêmur , Articulação do Joelho , Animais , Modelos Animais de Doenças , Fêmur , Cabeça do Fêmur/fisiopatologia , Articulação do Joelho/fisiopatologia , Pressão , Coelhos , Tíbia
19.
J Int Med Res ; 46(6): 2128-2140, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29848122

RESUMO

Background Cephalomedullary nails are frequently used in unstable intertrochanteric fractures. The implant position is an important factor for surgical success. Thus, in the present study, finite element analysis methods were used to investigate the biomechanical behavior of five different cephalomedullary nail positions in unstable intertrochanteric fractures. Methods Five different cephalomedullary nail implant positions were investigated. The observed indicators were the maximum displacement of the lag screw, the stress on the intertrochanteric fracture with involvement of the posteromedial cortex, and the tip-apex distance. Results The smallest lag screw displacement was achieved when the implant was closer to the inferior femoral head. Lower stress was placed on the posteromedial cortex when the implant was positioned closer to the inferior femoral head. However, the tip-apex distance increased when the lag screw was positioned more inferiorly. Conclusions The results of this study suggest that positioning the lag screw closer to the inferior aspect of the femoral head can reduce stress on the posteromedial cortex and deformation of the implant in unstable intertrochanteric fractures. These findings provide a biomechanical basis for selection of the cephalomedullary nail implantation site. Level of evidence III.


Assuntos
Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Simulação por Computador , Cabeça do Fêmur/fisiopatologia , Análise de Elementos Finitos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/fisiopatologia , Humanos , Modelos Anatômicos , Resultado do Tratamento
20.
J Pediatr Orthop ; 38(7): e377-e381, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29727407

RESUMO

BACKGROUND: Previous reports on patients with developmental dysplasia of the hip (DDH) showed that the prereduced femoral head was notably smaller and more nonspherical than the intact head, with growth failure observed at the proximal posteromedial area. We evaluated the shape of the femoral head cartilage in patients with DDH before and after reduction, with size and sphericity assessed using 3-dimensional (3D) magnetic resonance imaging (MRI). METHODS: We studied 10 patients with unilateral DDH (all female) who underwent closed reduction. Patients with avascular necrosis of the femoral head on the plain radiograph 1 year after reduction were excluded. 3D MRI was performed before reduction and after reduction, at 2 years of age. 3D-image analysis software was used to reconstruct the multiplanes. After setting the axial, coronal, and sagittal planes in the software (based on the femoral shaft and neck axes), the smallest sphere that included the femoral head cartilage was drawn, the diameter was measured, and the center of the sphere was defined as the femoral head center. We measured the distance between the center and cartilage surface every 30 degrees on the 3 reconstructed planes. Sphericity of the femoral head was calculated using a ratio (the distance divided by each radius) and compared between prereduction and postreduction. RESULTS: The mean patient age was 7±3 and 26±3 months at the first and second MRI, respectively. The mean duration between the reduction and second MRI was 18±3 months. The femoral head diameter was 26.7±1.5 and 26.0±1.6 mm on the diseased and intact sides, respectively (P=0.069). The ratios of the posteromedial area on the axial plane and the proximoposterior area on the sagittal plane after reduction were significantly larger than before reduction (P<0.01). CONCLUSIONS: We demonstrated that the size of the reduced femoral head was nearly equal to that of the intact femoral head and that the growth failure area of the head before reduction, in the proximal posteromedial area, was remodeled after reduction. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Cabeça do Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico por imagem , Imageamento Tridimensional , Imagem por Ressonância Magnética , Pré-Escolar , Feminino , Cabeça do Fêmur/anormalidades , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Luxação Congênita de Quadril/fisiopatologia , Luxação Congênita de Quadril/cirurgia , Humanos , Lactente , Estudos Longitudinais , Osteotomia
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