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1.
J Shoulder Elbow Surg ; 28(11): 2205-2214, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31630751

RESUMO

BACKGROUND: Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA. METHODS: All patients with RA who underwent TEA at a single center with a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up. RESULTS: We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components. CONCLUSION: TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo/métodos , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Idoso , Artrite Reumatoide/fisiopatologia , Artroplastia de Substituição do Cotovelo/efeitos adversos , Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Prótese de Cotovelo/efeitos adversos , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Força Muscular , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Pronação , Desenho de Prótese/efeitos adversos , Falha de Prótese , Amplitude de Movimento Articular , Reoperação , Resultado do Tratamento
2.
Bull Soc Pathol Exot ; 112(2): 114-118, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31478616

RESUMO

Implant of artificial penile nodule (APN) is a socio-cultural practice, linked to penitentiary environment in French Guiana. Physicians are often unfamiliar with its existence. Although serious complications remain low regarding the high prevalence of this practice, urgent cares could be required. Indeed, implant of nodule can have functional sequelae, and sometimes life-threatening consequences, especially if infection occurs and spreads. We have reported the case of a 23-year-old male who presented an infection of the penis after the implant of two APN. Removal of the nodules associated with oral antibiotics was needed. We also present CT-scan images of another patient, as an example of fortuitous discovery of these nodules. We finally discuss the various complications already described in literature.


Assuntos
Doenças do Pênis/diagnóstico , Prótese de Pênis/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Administração Oral , Antibacterianos/administração & dosagem , Remoção de Dispositivo , Guiana Francesa , Humanos , Masculino , Doenças do Pênis/tratamento farmacológico , Doenças do Pênis/cirurgia , Prisões , Desenho de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Adulto Jovem
3.
BMC Musculoskelet Disord ; 20(1): 415, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31488129

RESUMO

BACKGROUND: The aim of this study was to review the long-term results of the instrumented Bone Preserving (iBP) elbow prosthesis. METHODS: Thirty-one patients (10 M, 21F, 28-77 year) were retrospectively evaluated using the Oxford Elbow Score (OES), Disabilities of Arm, Shoulder and Hand Outcome Measure (DASH), Mayo Elbow Performance (MEPS), physical examination and standard radiographs. Kaplan-Meier survival analysis was used. RESULTS: Thirty-seven primary iBPs have been placed in 31 patients between 2000 and 2007. Six patients (8 prostheses) had died, 10 elbows had been revised and three patients (4 prostheses) were lost to follow-up. Fourteen patients (15 prostheses) were available for follow-up. The main indication for surgery was rheumatoid arthritis. Mean follow-up was 11 years (8-15). Kaplan-Meier survival analysis showed a survival of 81% at 10 years after surgery. Main reason for revision was particle disease and loosening due to instability and malalignment. Eleven of 14 patients were satisfied, although radiographs showed radiolucencies in 11 patients. CONCLUSION: The iBP elbow prosthesis gives a survival rate of 81% 10 years after surgery with a progressive decline beyond 10 years. However, many patients have radiolucencies. Discrepancy between clinical signs and radiological results warrants structural follow-up, to assure quality of bone stock in case revision surgery is indicated. The study was reviewed and approved by the Medical Ethical Committee of University Medical Center Groningen (METc2016/038). LEVEL OF EVIDENCE: Level IV, Case series.


Assuntos
Artroplastia de Substituição do Cotovelo/instrumentação , Prótese de Cotovelo/efeitos adversos , Próteses Articulares Metal-Metal/efeitos adversos , Metais/efeitos adversos , Falha de Prótese , Adulto , Idoso , Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo/efeitos adversos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/instrumentação , Osteoartrite/cirurgia , Satisfação do Paciente , Desenho de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
4.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
5.
Bone Joint J ; 101-B(7): 779-786, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256663

RESUMO

AIMS: The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model. MATERIALS AND METHODS: A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an in vitro model using paired fresh frozen cadaveric femora. RESULTS: The prevalence of early revision for periprosthetic fracture was 0.34% (1180/337 647) and 44.0% (520/1180) occurred within 90 days of surgery. Implant risk factors included: collarless stem, non-grit-blasted finish, and triple-tapered design. In the in vitro model, a medial calcar collar consistently improved the stability and resistance to fracture. CONCLUSION: Analysis of features of stem design in registry data is a useful method of identifying implant characteristics that affect the risk of early periprosthetic fracture around a cementless femoral stem. A collar on the calcar reduced the risk of an early periprosthetic fracture and this was confirmed by biomechanical testing. This approach may be useful in the analysis of other uncommon modes of failure after THA. Cite this article: Bone Joint J 2019;101-B:779-786.


Assuntos
Artroplastia de Quadril/instrumentação , Fraturas do Quadril/prevenção & controle , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Fenômenos Biomecânicos , Criança , Feminino , Seguimentos , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Sistema de Registros , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
6.
J Shoulder Elbow Surg ; 28(10): 1886-1896, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255444

RESUMO

BACKGROUND: Despite stemless implants showing promising functional and radiologic clinical outcomes, concerning signs of complications, such as bone resorption, have been reported. The aim of this study was to investigate the influence of 5 stemless designs on the bone adaptation process of the humerus. METHODS: Three-dimensional finite element models of shoulder arthroplasties were developed considering stemless designs based on the Eclipse, Global Icon, SMR, Simpliciti, and Sidus stemless systems. For the designs not possessing a collar that covers the entire resected surface of the humerus, conditions of contact and no contact were simulated between the humeral head components and the bone surface. By use of a bone remodeling model, computational simulations were performed considering 6 load cases of standard shoulder movements. The bone adaptation process was evaluated by comparing differences in bone density between the implanted models and the intact model of the humerus. RESULTS: Overall, the design of the stemless implants had a relevant impact on the bone adaptation process of the humerus. The Eclipse-based design caused the largest bone mass loss, whereas the SMR-based design caused the least. When contact was simulated between the humeral head components of the SMR-, Simpliciti-, and Sidus-based designs and the resected bone surface, bone resorption increased. DISCUSSION: Considering only the bone adaptation process, the results suggest that the SMR-based implant presents the best performance and that contact between the humeral head component and the resected bone surface should be avoided. However, because other factors must be considered, further investigation is necessary to allow definite recommendations.


Assuntos
Artroplastia do Ombro/instrumentação , Úmero/fisiopatologia , Desenho de Prótese/efeitos adversos , Prótese de Ombro/efeitos adversos , Adaptação Fisiológica , Densidade Óssea , Remodelação Óssea , Reabsorção Óssea , Simulação por Computador , Análise de Elementos Finitos , Humanos , Úmero/cirurgia , Masculino , Modelos Anatômicos
7.
J Orthop Surg Res ; 14(1): 225, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324195

RESUMO

BACKGROUND: Several hydroxyapatite (HA)-coated femoral stems from a single manufacturer were identified to have aseptically loosened at mid-term follow-up despite prior radiographic appearance of osseointegration. Possible causes and associated risk factors for stem loosening were explored through radiographic review and implant retrieval analysis. METHODS: Forty-six retrieved hip stems (Corail, DePuy-Synthes) were identified and grouped by bearing type: metal-on-metal (MoM), metal-on-polyethylene, and ceramic-on-ceramic. Stem lucency was graded on post-operative radiographs up to the time of revision. Stems were examined for stripping of the HA coating, taper corrosion, and bearing wear in metal-on-metal cases. Patient demographics, implant design features, and perioperative data were collected from electronic databases and patient charts. RESULTS: Aseptic loosening occurred in 37% of cases examined. MoM bearings were associated with 7.25 times greater risk of loosening compared to other bearing types. Stem radiolucency was more prevalent for MoM cases and, although not statistically significant, demonstrated progressive lucency. Taper corrosion appeared more severe for MoM cases and correlated with proximal stem radiolucency. Removal of the HA coating from the stems was associated with both taper corrosion and MoM bearing wear. Length of implantation was a confounding factor for the MoM cases. CONCLUSION: This study has demonstrated a high risk of mid-term loosening of previously osseointegrated HA-coated femoral stems when paired with a MoM bearing. The mechanism of loosening appears progressive in nature and related to the MoM bearing, possibly interacting with the HA coating. If such loosening is recognized early, rapid revision may allow for retention of the femoral stem.


Assuntos
Durapatita/normas , Análise de Falha de Equipamento/normas , Fêmur/cirurgia , Prótese de Quadril/normas , Próteses Articulares Metal-Metal/normas , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Durapatita/efeitos adversos , Análise de Falha de Equipamento/métodos , Feminino , Seguimentos , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Próteses Articulares Metal-Metal/efeitos adversos , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Desenho de Prótese/normas , Falha de Prótese/efeitos adversos , Estudos Retrospectivos
8.
J Shoulder Elbow Surg ; 28(12): 2308-2316, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31324502

RESUMO

BACKGROUND: This study reports the clinical and radiographic outcomes of a hybrid cage glenoid compared with an age-matched, sex-matched, and follow-up-matched cohort of cemented all-polyethylene peg glenoids in patients undergoing anatomic total shoulder arthroplasty with 2 years' minimum follow-up. MATERIALS AND METHODS: We reviewed 632 primary anatomic total shoulder arthroplasty patients from an international multi-institutional database; 316 patients received hybrid cage glenoids and were matched for age, sex, and follow-up with 316 patients with cemented all-polyethylene peg glenoids. Each cohort received the same humeral component. Scoring was performed in all patients preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range-of-motion measurements. A Student 2-tailed unpaired t test identified differences in outcomes; P < .05 denoted a significant difference. RESULTS: Cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P = .0088) than all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred. In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P = .0088). CONCLUSION: At 50 months' mean follow-up, cage glenoids demonstrated equally good clinical outcomes to all-polyethylene peg glenoids. Cage glenoids had significantly fewer radiolucent lines around both the glenoid and humeral components and a lower revision rate. Longer-term follow-up is required to confirm these promising short-term results.


Assuntos
Artroplastia do Ombro/instrumentação , Cavidade Glenoide/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Prótese de Ombro , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polietileno , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Reoperação , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
9.
Bone Joint J ; 101-B(5): 559-564, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039001

RESUMO

AIMS: The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA). PATIENTS AND METHODS: The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively. RESULTS: Differences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively. CONCLUSION: Clinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559-564.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Polietileno/administração & dosagem , Desenho de Prótese/métodos , Vitamina E/administração & dosagem , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Reagentes para Ligações Cruzadas , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Desenho de Prótese/efeitos adversos , Amplitude de Movimento Articular
10.
Bone Joint J ; 101-B(5): 610-614, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039055

RESUMO

AIMS: Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). PATIENTS AND METHODS: A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4). RESULTS: Greater tuberosity stress shielding was noted in 14 shoulders (two TSA and 12 RSA) and was graded as mild in nine, moderate in two, and severe in three. Medial calcar resorption was noted in 23 shoulders (seven TSA and 16 RSA), and was graded as mild in 21 and moderate in two. No humeral components were revised for loosening or considered to be loose radiologically. Nine shoulders underwent reoperation for infection (n = 3), fracture of the humeral tray (n = 2), aseptic glenoid loosening (n = 1), and instability (n = 3). No periprosthetic fractures occurred. CONCLUSION: Implantation of this particular short cementless humeral component at the time of TSA or RSA was associated with a low rate of adverse radiological findings on the humeral side at mid-term follow-up. Our data do not raise any concerns regarding the use of a short stem in TSA or RSA. Cite this article: Bone Joint J 2019;101-B:610-614.


Assuntos
Artroplastia do Ombro/métodos , Úmero/cirurgia , Falha de Prótese/efeitos adversos , Prótese de Ombro/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/efeitos adversos , Feminino , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
11.
BMC Musculoskelet Disord ; 20(1): 261, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142303

RESUMO

BACKGROUND: Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs. METHODS: A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery. RESULTS: Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1-99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0-1.2); p = 0.001). CONCLUSIONS: The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term. LEVEL OF EVIDENCE: Diagnostic Level IV.


Assuntos
Artroplastia de Quadril/efeitos adversos , Osso Cortical/patologia , Fêmur/patologia , Prótese de Quadril/efeitos adversos , Dor Pós-Operatória/epidemiologia , Idoso , Artroplastia de Quadril/instrumentação , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Hipertrofia/etiologia , Hipertrofia/patologia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Desenho de Prótese/efeitos adversos , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
12.
Orthop Traumatol Surg Res ; 105(3): 523-527, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954391

RESUMO

INTRODUCTION: Intramedullary (IM) nailing is the gold standard treatment for tibial shaft fractures, but can be associated with various mechanical complications, including delayed union. HYPOTHESIS: We believe that complications do not occur randomly, but in certain conditions that contribute to their development. Risk factors likely to predict delayed union can be identified to support prevention. MATERIALS AND METHODS: A cohort of 171 fractures treated by IM nailing between 2005 and 2015 was reviewed retrospectively. Independent variables included intrinsic, patient-related factors and extrinsic factors such as those related to the fracture or surgery. A multiple logistic regression model was used to determine which factors can predict each type of complication. RESULTS: Delayed union occurred in 22.8% of patients. Smoking and high-energy trauma were risk factors. Hardware breakage was significantly reduced (p<0.05) when the nail diameter was greater than 10mm. A nail diameter/reamer diameter ratio outside the recommended limits (0.80-0.99) was more likely to be associated with screw failure. Diabetes is a risk factor for hardware migration, which itself is associated with other complications. DISCUSSION: Nonunion is the most common complication after IM nailing of tibial shaft fractures. Smoking cessation after a fracture is necessary in our opinion, even if the literature is ambivalent on this aspect and stopping to smoke once the fracture occurs may not be sufficient to prevent a poor outcome. Use of a nail diameter/reamer diameter between 0.80 and 0.99 favors union and prevents hardware breakage. Hardware migration in a diabetic patient may be a warning sign of other types of complications. LEVEL OF EVIDENCE: Retrospective cohort study. Level IV.


Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Consolidação da Fratura , Fraturas não Consolidadas/etiologia , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes/complicações , Diáfises/lesões , Diáfises/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Falha de Prótese/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Resultado do Tratamento , Adulto Jovem
13.
Arch Orthop Trauma Surg ; 139(7): 991-998, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30927062

RESUMO

BACKGROUND: Easy revisability is gaining increasingly in importance. The removal of well-fixed cemented stems is very demanding and is often associated with increased operative morbidity. Implant design may be here a decisive impact factor, and the best way to ascertain it is experimentally. Aim of this study is to assess different cemented stems of established knee revision implants in regard to their removal capability. METHODS: Based on their sagittal profile, five stem extensions from known manufacturers were divided in conical, conical-cylindrical and cylindrical designs. The pedicles were also characterized in respect to their cross section, diameter and surface roughness. The cemented stems were dismounted six times each in a reproducible biomechanical setup. The explantation energy required was determined and statistical analyzed. RESULTS: The conical shaft needed significantly the slightest explantation energy with 19.2 joules (p = 0.004). There was a strong negative linear correlation between conicity proportion and explantation energy of the cemented stems (R2 = 0.983). The removal of the three purely cylindrical shafts-regardless of their differences in diameter, cross-sectional design and surface- was the most demanding (98.3, 105, and 116.7 joules) with only secondary differences between them. CONCLUSION: The longitudinal stem profile may have a primary impact on the explantability of well-fixed cemented shafts with conical designs showing superiority. Cross-sectional profile and surface roughness had here a less decisive influence on the explantability. Surgeons can choose proper implants and removal techniques depending on potential implant-associated revision risks and re-revisions to be expected.


Assuntos
Artroplastia do Joelho , Remoção de Dispositivo/métodos , Articulação do Joelho , Prótese do Joelho , Desenho de Prótese , Reoperação/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Estudos Transversais , Análise de Falha de Equipamento , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Prótese do Joelho/classificação , Teste de Materiais , Desenho de Prótese/efeitos adversos , Desenho de Prótese/métodos
14.
J Knee Surg ; 32(11): 1058-1062, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30754069

RESUMO

The ongoing debate on fixation in total knee arthroplasty (TKA) has become increasingly relevant with its increased use in a younger patient population and the advent of novel cementless prostheses. Recent literature suggests modern cementless implants are comparable to their cemented counterparts in terms of survivorship and functional outcomes. What has not been well-assessed is whether the two modalities differ with respect to infection rates which was the purpose of this study. Specifically, a propensity score matched study population was used to compare: (1) overall infection; (2) prosthetic joint infection (PJI); and (3) surgical site infection (SSI) rates between cementless and cemented TKAs. Using a large institutional database, 3,180 consecutive primary TKAs were identified. Cementless and cemented TKA patients were propensity score matched by age (p = 0.069), sex (p = 0.395), body mass index (BMI; p = 0.308), and Charlson's comorbidity index (CCI) score (p = 0.616) in a 1:1 ratio. Univariate analysis was performed to compare 2-year overall infection rates. Infections were further analyzed separately as PJIs (deep joint infections requiring surgery) and SSIs (skin/superficial wound infections). Multivariate logistic regression was performed to evaluate infection incidences after adjusting for procedure-related factors (i.e., operative time, hospital volume, and surgeon volume). There were no significant differences between the matched cohorts in terms of overall infection rates (3.8 vs. 2.3%, p = 0.722), as well as when PJI (p = 1.000) and SSI (p = 1.000) rates were analyzed separately. Multivariate analysis revealed no significant differences in overall postoperative infection rates (p = 0.285), PJI rates (p = 0.446), or SSI rates (p = 0.453) even after adjusting for procedure-related factors. There is increasing literature investigating various outcomes demonstrating the comparable efficacies of cementless versus cemented TKAs. To the best of the author's knowledge, this was the first matched case-control study to directly compare their post-operative infection rates. The findings from this study show that post-operative infection rates were similar between fixation modalities even after accounting for a range of patient- and procedure-related factors.


Assuntos
Artrite Infecciosa/epidemiologia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Cimentos para Ossos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Desenho de Prótese/efeitos adversos
15.
Foot Ankle Clin ; 24(1): 163-171, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30685009

RESUMO

Avascular necrosis tends to occur in the talus because of poor blood supply caused by the extended coverage to the articular cartilage on its surface. Treatment is conservative in the earlier stage of this disease; however, surgical treatment is usually indicated in the advanced stage. Nonunion, leg length discrepancy, or hindfoot instability may occur in patients treated with ankle or tibio-talo-calcaneal fusion. Arthroplasty using a customized total talar prosthesis designed using the computed tomography image of contralateral talus has the potential advantages of weightbearing in the earlier postoperative phase, prevention of lower extremity discrepancy, and maintenance of joint function.


Assuntos
Artrodese/métodos , Artroplastia de Substituição do Tornozelo/métodos , Osteonecrose/cirurgia , Tálus/cirurgia , Óxido de Alumínio/administração & dosagem , Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/instrumentação , Humanos , Prótese Articular/efeitos adversos , Desenho de Prótese/efeitos adversos , Desenho de Prótese/métodos , Tálus/patologia
16.
J Am Acad Orthop Surg ; 27(6): 200-209, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30260909

RESUMO

Scapular notching is a common radiographic finding occurring after reverse total shoulder arthroplasty, and it refers to an erosive lesion of the inferior scapular neck because of the impingement of the humeral implant during adduction. The clinical importance of notching is unclear, and the optimal treatment of severe notching is unknown. The incidence and severity of scapular notching is related to prosthetic design and surgical technique. Implant design factors include size, shape, and position of the glenosphere, inclination of the humeral neck-shaft angle, implant offset, and native scapular anatomy. Scapular notching may lead to deterioration of functional outcomes and glenoid implant loosening and failure. Lateral offset, inferior glenosphere overhang, and careful consideration of the presurgical glenoid morphology may help prevent scapular notching. Currently, there is limited evidence to direct the management of scapular notching, and further research is needed to elucidate optimal prevention and treatment strategies.


Assuntos
Artroplastia do Ombro/efeitos adversos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese/efeitos adversos , Síndrome de Colisão do Ombro/etiologia , Prótese de Ombro/efeitos adversos , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Escápula/fisiopatologia , Escápula/cirurgia , Síndrome de Colisão do Ombro/epidemiologia , Síndrome de Colisão do Ombro/fisiopatologia
17.
Eur J Orthop Surg Traumatol ; 29(1): 97-102, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29855788

RESUMO

INTRODUCTION: It has been suggested that one of the factors related to persistent post-operative pain following total hip arthroplasty (THA) is to over sizing of the acetabular component. In order to investigate this potential issue, we retrospectively analysed a series of consecutive uncemented THA. We assessed the incidence of persistent post-operative pain and the size difference between the implanted acetabular component and the native femoral head. METHODS: A total of 265 consecutive THAs were retrospectively identified. Standardised pre-operative radiographs were analysed using validated techniques to determine the native femoral head diameter. Post-operative standardised radiographs were reviewed and the acetabular orientation determined. Patients were sent postal questionnaires regarding their outcome and level of pain. RESULTS: Questionnaires were returned by 169 patients (189 hips, 71% response rate). A total of 17 were excluded due to inadequate radiographs., leaving 172 THA in the study group. The mean native femoral head (NFH) size was 47 mm. The most common implanted acetabular component size was 52 mm. The mean difference in cup to NFH diameter (delta) was 5.7 mm (range - 6.1 to 15.4 mm; 95% CI 5.3-6.2 mm). A delta of > 6 mm was found to be significant for predicting persistent post-operative pain (RR = 1.81; 95% CI 1.1-3.1; P = 0.027). CONCLUSION: Our study confirms that a delta of > 6 mm is associated with an increased risk of persistent post-operative pain following THA. We recommend pre-operative templating in all uncemented THA to ensure the planned acetabular component is no more than 6 mm larger than the NFH diameter.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cabeça do Fêmur/anatomia & histologia , Prótese de Quadril/efeitos adversos , Dor Pós-Operatória/etiologia , Desenho de Prótese/efeitos adversos , Acetábulo/cirurgia , Adulto , Idoso , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Radiografia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Hip Int ; 29(2): 177-183, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29682992

RESUMO

INTRODUCTION:: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures in elderly patients. Recently, short tapered-wedge cementless stems have increasingly been used in this population. However, historic data has consistently shown higher rates of periprosthetic fracture with uncemented stems in hip fracture patients. This study aims to evaluate the rate of periprosthetic fracture requiring re-operation and all-cause mortality between cemented and uncemented femoral stem designs including more recent short tapered-wedge cementless stems in hip fracture patients. METHODS:: A retrospective chart and radiographic review of patients received bipolar hemiarthroplasty for femoral neck fractures from 2010-2016. Patients biologically (age ≥ 65 years) or physiologically (American Society of Anesthesiologists (ASA) class ≥ 3) elderly were eligible. The uncemented group was subdivided into tapered-wedge stems (a broach only system) and reamed uncemented stems. The primary outcome was periprosthetic fracture requiring re-operation. RESULTS:: We included 657 patients in total, with 296 and 361 patients in the uncemented and cemented stem groups respectively. In the uncemented group there were 197 tapered-wedge and 99 reamed uncemented stems. There was a significantly higher rate of periprosthetic fracture requiring re-operation in the uncemented group (3.0% vs. 0.6%) ( p ≤ 0.05). There were no significant differences in rates of all-cause mortality, infection or all-cause re-operation. CONCLUSIONS:: Compared to modern uncemented femoral stem designs, cemented stems yield lower rates of periprosthetic fracture requiring re-operation, without increasing risk of all-cause mortality. Tapered-wedge stems had similar rates of re-operation due to periprosthetic fracture as reamed uncemented stems.


Assuntos
Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Hemiartroplastia/instrumentação , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/epidemiologia , Desenho de Prótese/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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