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1.
Medicine (Baltimore) ; 99(3): e18784, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011474

RESUMO

RATIONALE: Allograft-prosthetic composites (APCs) and proximal femoral replacement have been applied for reconstruction of severe segmental femoral bone loss in revision total hip arthroplasty. The outcomes are encouraging but the complication rate is relatively high. Considering the high complication rates and mixed results of APCs and megaprosthesis, we presented a case using personalized 3D printed Titanium sleeve-prosthetic composite for reconstruction of segmental bone defect. PATIENT CONCERNS: A 73-year-old woman presented to the emergency department on account of acute severe pain of the left hip without history of trauma. She had undergone a cemented total hip arthroplasty for osteonecrosis of femoral head at the left side in 2000. In 2013 she underwent a cemented revision total hip arthroplasty as a result of aseptic loosening of hip prosthesis. She denied obvious discomfort prior to this episode since the revision surgery in 2013. DIAGNOSIS: According to the clinical history, imaging and physical examination, we confirmed the diagnosis of severe segmental bone loss of proximal femur and fracture of prosthetic stem. The femoral bone defect was evaluated using the Paprosky classification system and rated as Type 3B, and the acetabular bone defect was rated as Type 2C. INTERVENTIONS: In this study, we present the first case of severe segmental bone loss of proximal femur in revision total hip arthroplasty that was successfully treated using personalized 3D printed Titanium sleeve-prosthetic composite OUTCOMES:: At the 2-year follow-up, the patient was symptom free with a Harris Hip Score of 91. Radiographs showed excellent osteointegration between the interface of sleeve-prosthetic composite and the host bone, with no signs of implant loosening or subsidence. LESSONS: Despite the absence of long term results of 3D printed Titanium sleeve-prosthetic composite reconstruction, the good clinical and radiological outcome at 2 years follow up implied its potential role for reconstruction of segmental femoral bone defect in revision THA.


Assuntos
Artroplastia de Quadril , Doenças Ósseas/cirurgia , Prótese de Quadril , Medicina de Precisão , Impressão Tridimensional , Desenho de Prótese/métodos , Idoso , Doenças Ósseas/diagnóstico por imagem , Feminino , Fêmur , Humanos , Medicina de Precisão/métodos , Falha de Prótese , Reoperação , Titânio
2.
J Surg Oncol ; 121(3): 570-577, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902136

RESUMO

BACKGROUND: Joint-preserving intercalary tumor resection can result in better proprioception and a more normal joint function after reconstruction. However, most reported reconstruction techniques are usually associated with frequent complications. Therefore, the approach of reconstruction following joint-preserving tumor resection warrants further study. METHODS: Between September 2016 and October 2018, 12 patients with metaphyseal malignant bone tumors around the knee joint were treated by joint-preserving intercalary resections with the aid of three-dimensional (3D)-printed osteotomy guide plates and reconstructions using 3D-printed intercalary prostheses. We assessed the accuracy of the resection by comparing the cross sections at the resection plane with 3D-printed matching surface of the prostheses. The functional outcomes, complications and oncological status were also evaluated. RESULTS: All patients were observed for 7 to 32 months with an average follow-up of 22.5 months. The achieved resection was accurate, with accurate matching between the residual bone and prosthesis. The mean MSTS score was 28 (range, 26-30). Superficial infection occurred in two patients. Local recurrence was observed in one patient, while pulmonary metastasis was identified in one patient. CONCLUSIONS: The personalized osteotomy guide plate and prosthesis based on 3D printing technique facilitate joint-preserving tumor resection and functional reconstruction. However, longer follow-up and larger sample size are required to clarify its long-term outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Doenças Ósseas/cirurgia , Neoplasias Ósseas/cirurgia , Articulação do Joelho/cirurgia , Tratamentos com Preservação do Órgão/métodos , Impressão Tridimensional/instrumentação , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Neoplasias Ósseas/patologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Prognóstico , Desenho de Prótese , Estudos Retrospectivos
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1196-1199, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512465

RESUMO

Objective: To review the research progress of the surgical treatment for lateral malleolus defect. Methods: The related literature about surgical treatment and effectiveness of lateral malleolus defect at home and abroad was reviewed, summarized, and analysed. Results: Lateral malleolus defects are often caused by severe trauma or wide resection of fibular neoplasms. Although the incidence is not high, the defects are difficult to handle. These bony defects should be reconstructed to prevent an abnormal gait induced by ankle instability and avoid the occurrence of traumatic arthritis. Various repair methods have been developed, including bone transplantation, fibula lengthening, and ankle arthrodesis. Conclusion: There are various surgical methods to repair the defect of lateral malleolus, but each has its own advantages and disadvantages. In order to achieve the best results, the surgeon should choose the appropriate operation according to his own level, the patient's specific injury, and age.


Assuntos
Doenças Ósseas , Fíbula , Articulação do Tornozelo , Doenças Ósseas/cirurgia , Transplante Ósseo , Osso e Ossos/anormalidades , Fíbula/anormalidades , Fíbula/patologia , Fíbula/cirurgia , Humanos
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(10): 1320-1325, 2019 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-31544446

RESUMO

Objective: To summarize the research progress of surgical procedures in osteochondral lesions of the talus (OLT). Methods: By consulting the related literature of OLT in recent years, the advantages and disadvantages of various surgical treatment schemes were analyzed and summarized. Results: There are many surgical treatments for OLT, including bone marrow stimulation, osteochondral transplantation, autologous chondrocyte transplantation, and biologically assisted therapy. Various schemes have different indications and limitations. With the continuous development of various technologies, the effectiveness of OLT treatment will gradually improve. Conclusion: There are still many difficulties and controversies in the treatment of OLT, and there is no unified treatment plan. It is suggested that individualized operation plan should be formulated according to the specific conditions of patients.


Assuntos
Doenças Ósseas/cirurgia , Tálus , Artroscopia , Transplante Ósseo , Cartilagem Articular , Condrócitos , Humanos , Transplante Autólogo
5.
Med Sante Trop ; 29(2): 127-132, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379336

RESUMO

The induced membrane technique is a simple and effective method for reconstructing bone defects in limbs. It is suited to low resource settings, if sufficient care is taken in preparing and performing the technique. Key points for the success of this procedure are described here. In austere environments, its use is mostly limited by possibilities for treatment of bone infection, but also by access to surgical cement and available bone stock. Alternatives for overcoming these last two obstacles are presented.


Assuntos
Doenças Ósseas/cirurgia , Transplante Ósseo/métodos , Osso e Ossos/lesões , Osso e Ossos/cirurgia , Regeneração Tecidual Guiada/métodos , Doenças Ósseas/microbiologia , Recursos em Saúde , Humanos , Membranas
6.
J Orthop Surg Res ; 14(1): 280, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462273

RESUMO

BACKGROUND: Revision total knee arthroplasty (rTKA) is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation. The aim of this study is to describe the outcomes of a consecutive series of rTKA. Furthermore, a modified bone loss classification will be proposed based also on bone quality. Finally, the association between radiolucent line (RLL) development and different risk factors will be evaluated. METHODS: All the patients who underwent rTKA between 2008 and 2016 in the same institution were included. rTKAs were performed by the same surgeon according to the three-step technique. Bone losses were classified according to the proposed classification, including bone quality evaluation. The Knee Scoring System (KSS), the Hospital for Special Surgery Knee Score (HSS), and the SF-12 were used for the clinical evaluation. Radiological evaluation was performed according to the Knee Society Roentgenographic Evaluation System. Different possible risk factors (i.e., gender, age, amount of bone losses) associated to RLL development were identified, and this association was evaluated using logistic regression. RESULTS: Fifty-one patients (53 knees) were included (60.8% female, average age 71.5 years). The average follow-up was 56.6 months (range 24-182). The most frequent cause of failure was aseptic loosening (41.5%). 18.9% of the cases demonstrated poor bone quality. Bone losses were treated according to the proposed algorithm. In all the cases, there was a significant improvement in all the scores (P < 0.05). The average post-operative range of motion was 110.5° (SD 10.7). At the radiological evaluation, all the implants resulted well aligned, with 15.1% of non-progressive RLL. There were 2 failures, with a cumulative survivorship of 92.1% at the last follow-up (SD 5.3%). At the logistic regression, none of the evaluated variables resulted associated to RLL development. CONCLUSION: rTKA is a demanding procedure, and adequate treatment of bone losses is mandatory to achieve good results. However, also bone quality should be taken into consideration when approaching bone losses, and the proposed classification may need surgeons after an adequate validation. LEVEL OF EVIDENCE: Level IV.


Assuntos
Artroplastia do Joelho/normas , Doenças Ósseas/cirurgia , Complicações Pós-Operatórias/cirurgia , Qualidade da Assistência à Saúde/normas , Reoperação/normas , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/tendências , Doenças Ósseas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Qualidade da Assistência à Saúde/tendências , Reoperação/tendências , Resultado do Tratamento
7.
J Int Adv Otol ; 15(2): 193-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31287439

RESUMO

Petrous apex cholesterol granulomas (PACG) are rare disorders that can lead to patient morbidity and must, occasionally, be drained by either endoscopic endonasal (EN) or open procedures (OP). The objective of our study was to complete a review of the literature to compare the EN and OP approaches on multiple levels, notably on safety and effectiveness. Ovid MEDLINE and Embase were used to perform a thorough literature review of all cases of PACG treated by either EN or OP dating from January 1948 to August 2017. In total, 49 articles were selected including 23 for EN (n=76) and 26 for OP (n=210). Differences were found in the incidence of preoperative hearing loss (HL) (EN 18.4%, OP 57.3%; p<0.001), headache (EN 48.7%, OP 31.2%; p=0.007), and disequilibrium (EN: 14.5%, OP 26.1%; p=0.04). Differences in lesion proximity to the sphenoid sinus (EN 23.6%, OP: 1.0%; p<0.001), clivus (EN 11.8%, OP 4.7%; p=0.03), otic capsule (EN 0.0%, OP 5.2%; p=0.03), internal auditory canal (EN 2.6%, OP 10.9%; p=0.01), and internal carotid artery (ICA) (EN 9.2%, OP 2.8%; p=0.02) were found on preoperative imaging. The EN procedure had better hearing improvement rates (EN 85.7%, OP 23.4%; p<0.001), lower complication rates (EN 7.9%, OP 17.6%; p=0.04), shorter median follow-up (EN:13.5 months, OP:37.2 months; p<0.001), and shorter time to recurrence (EN 3 months, OP 22.6 months; p=0.002) than the known OP. No differences were found in age, preoperative size, recurrence rate, operative time, stent placement, or improvement of other symptoms. Endoscopic nasal approaches, when feasible, should be favored to open procedures for PACG drainage given their better hearing improvement and less complication rates.


Assuntos
Doenças Ósseas/cirurgia , Colesterol , Endoscopia/métodos , Granuloma de Corpo Estranho/cirurgia , Osso Petroso/cirurgia , Adulto , Granuloma de Corpo Estranho/complicações , Transtornos da Cefaleia/etiologia , Perda Auditiva/etiologia , Humanos , Segurança do Paciente , Resultado do Tratamento , Vertigem/etiologia
8.
Int J Infect Dis ; 85: 175-181, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212103

RESUMO

BACKGROUND: The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. METHODS: A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. RESULTS: Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44). CONCLUSIONS: Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.


Assuntos
Doenças Ósseas/terapia , Artropatias/terapia , Infecções Relacionadas à Prótese/terapia , Infecções Estreptocócicas/terapia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Doenças Ósseas/tratamento farmacológico , Doenças Ósseas/microbiologia , Doenças Ósseas/cirurgia , Terapia Combinada , Desbridamento , Quimioterapia Combinada , Feminino , Prótese de Quadril/efeitos adversos , Humanos , Artropatias/tratamento farmacológico , Artropatias/microbiologia , Artropatias/cirurgia , Prótese do Joelho/efeitos adversos , Levofloxacino/uso terapêutico , Masculino , Prognóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Recidiva , Estudos Retrospectivos , Rifampina/uso terapêutico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/cirurgia , Streptococcus/isolamento & purificação , Streptococcus agalactiae/isolamento & purificação , Falha de Tratamento , Resultado do Tratamento
11.
World Neurosurg ; 128: 14-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054339

RESUMO

BACKGROUND: An epidermoid cyst arising from diploic space in the skull can cause an intracranial mass effect with compression of the underlying venous sinuses. CASE DESCRIPTION: A 66-year-old woman came to us with a persistent headache and unsteadiness. Computed tomography demonstrated an occipital bone cystic lesion with an intracranial mass effect overlying the torcular herophili, with high-intensity findings in diffusion-weighted magnetic resonance imaging. Cerebral angiogram demonstrated obstruction of the torcular herophili with development of diploic venous drainage. The patient underwent removal of the lesion and a cranioplasty procedure. The diagnosis was torcular epidermoid cyst. The postoperative course was uneventful, and the symptoms were resolved. CONCLUSIONS: Development of diploic venous drainage contributed to avoidance of critical intracranial hypertension during slow growth of a torcular epidermoid cyst.


Assuntos
Doenças Ósseas/complicações , Transtornos Cerebrovasculares/etiologia , Cavidades Cranianas , Cisto Epidérmico/complicações , Idoso , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cavidades Cranianas/patologia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Osso Occipital
12.
PLoS One ; 14(3): e0214384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30913254

RESUMO

Optimal treatment of bone fractures with minimal complications requires implant alloys that combine high strength with high ductility. Today, TiAl6V4 titanium and 316L steel are the most applied alloys in bone surgery, whereas both share advantages and disadvantages. The nickel-free, high-nitrogen austenitic steel X13CrMnMoN18-14-3 (1.4452, brand name: P2000) exhibits high strength in combination with superior ductility. In order to compare suitable alloys for bone implants, we investigated titanium, 316L steel, CoCrMo and P2000 for their biocompatibility and hemocompatibility (according to DIN ISO 10993-5 and 10993-4), cell metabolism, mineralization of osteoblasts, electrochemical and mechanical properties. P2000 exhibited good biocompatibility of fibroblasts and osteoblasts without impairment in vitality or changing of cell morphology. Furthermore, investigation of the osteoblasts function by ALP activity and protein levels of the key transcription factor RUNX2 revealed 2x increased ALP activity and more than 4x increased RUNX2 protein levels for P2000 compared to titanium or 316 steel, respectively. Additionally, analyses of osteoblast biomineralization by Alizarin Red S staining exhibited more than 6x increased significant mineralization of osteoblasts grown on P2000 as compared to titanium. Further, P2000 showed no hemolytic effect and no significant influence on hemocompatibility. Nanoindentation hardness tests of Titanium and 316L specimens exposed an indentation hardness (HIT) of about 4 GPa, whereas CoCrMo and P2000 revealed HIT of 7.5 and 5.6 GPa, respectively. Moreover, an improved corrosion resistance of P2000 compared to 316L steel was observed. In summary, we could demonstrate that the nickel-free high-nitrogen steel P2000 appears to be a promising alternative candidate for applications in bone surgery. As to nearly all aspects like biocompatibility and hemocompatibility, cell metabolism, mineralization of osteoblasts and mechanical properties, P2000 was similar to or revealed advantages against titanium, 316L or CoCrMo.


Assuntos
Substitutos Ósseos/química , Nitrogênio/química , Aço Inoxidável/química , Fosfatase Alcalina/metabolismo , Ligas/química , Ligas/farmacologia , Animais , Doenças Ósseas/cirurgia , Doenças Ósseas/terapia , Substitutos Ósseos/farmacologia , Substitutos Ósseos/uso terapêutico , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Subunidades alfa de Fatores de Ligação ao Core/metabolismo , Corrosão , Dureza , Camundongos , Osteoblastos/citologia , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Próteses e Implantes , Aço Inoxidável/farmacologia , Propriedades de Superfície
14.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(1): 51-53, 2019 Jan 30.
Artigo em Chinês | MEDLINE | ID: mdl-30770692

RESUMO

The evaluation concerns on custom design of implant for bony defect focus on engineered transformation of clinical needs, pre-operation performance verification and clinical validation. These concerns refer to manipulation on imageology information, tissue adhesion and fixation, surgery planning and instruments, design specification and instruction, finite element analysis, bench testing, around market clinical research et al. The evaluation integrates adaptive risk evaluation methods such as biomechanics, mechanobiology, blind crossover reproducility and dynamic design of clinical study et al.


Assuntos
Doenças Ósseas , Próteses e Implantes , Desenho de Prótese , Fenômenos Biomecânicos , Doenças Ósseas/cirurgia , Análise de Elementos Finitos , Humanos
15.
Arch Orthop Trauma Surg ; 139(7): 913-920, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30687872

RESUMO

INTRODUCTION: Total femoral replacement (TFR) is a limb salvage procedure performed for large bony defects. However, it is often associated with major complications and reduced function. Data on limb preservation rates and functional outcomes after TFR are limited. The primary objective of this study is to assess indications, functional outcomes, and complications after TFR. MATERIALS AND METHODS: We retrospectively analyzed all patients after TFR between 2006 and 2016. All patients received a modular mega endoprosthesis (MUTARS®). Patients were grouped according to their initial indication for TFR: (1) fracture, (2) tumor, or (3) infection. We evaluated (i) patient survival, (ii) postoperative function with the Musculoskeletal Tumor Society Score (MSTS), knee strength, range of motion, and (iii) complications. RESULTS: Between 2006 and 2016, TFR was performed in 22 patients with a mean age of 64 +/-17 years. Indications for TFR were tumor (n = 6), infection (n = 8) and fracture (n = 8). The mean follow-up (f/up) was 18 months. At final follow-up, mean MSTS was 24%. Mean knee flexion strength was reduced 63% compared to the contralateral leg (p = 0.004). At time of final f/up, 5 patients (22%) died, 5 (22%) underwent secondary hip exarticulation, and 12 (54%) suffered a major complication. At f/up, 11 patients had infections. Of these 11 patients, 5 died, 4 were treated with debridement, and 5 were treated with hip exarticulation. Fifteen patients survived with preserved limbs at f/up. CONCLUSION: TFR is a salvage procedure with limited functional outcome and high complication rates. Nevertheless, the majority of our cohort could be treated successfully with limb salvage.


Assuntos
Doenças Ósseas/cirurgia , Fêmur , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Idoso , Feminino , Fêmur/lesões , Fêmur/patologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/reabilitação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
16.
Cir Cir ; 87(1): 96-100, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30600810

RESUMO

Background: Langerhans cell histiocytosis is a rare disease in the adult, predominates in the pediatric age and is more common in men than in women. The sites of greater affection are the long bones, followed by the bones of the skull. Patients usually have symptoms related to the site of affection, usually polyostotic lesions, monostotic lesions occur less frequently. The study of choice and treatment depends on the site affected, in the skull the main one is the magnetic resonance and the treatment is the surgical excision of the lesion. Clinical Case: A 29-year-old female patient who entered the hospital due to a non-painful, rapidly growing, progressive tumor on the frontal region of the skull. Physical examination revealed a rounded mass of approximately 5 cm in diameter in the left, non-painful, non-painful, left-frontoparietal region. Magnetic resonance imaging of the skull showed a lytic lesion in the frontal bone. It was surgically excised with clean edges; titanium plate was placed. Histopathological diagnosis was histiocytosis of Langerhans cells. Conclusions: It is a rare case, with a patient of an uncommon age of presentation, absence of metastasis by means of study protocol and due to the monostotic presentation improves the prognosis for this patient.


Assuntos
Doenças Ósseas , Osso Frontal , Histiocitose de Células de Langerhans , Adulto , Doenças Ósseas/diagnóstico , Doenças Ósseas/cirurgia , Feminino , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/cirurgia , Humanos
18.
Infection ; 47(2): 301-305, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30128751

RESUMO

Musculoskeletal hydatidosis is a rare but severe disease in central Europe. This case report presents the incidental finding of an osseous hydatidosis after cementless revision total hip arthroplasty in a patient without a preoperative history of hydatidosis or any clinical symptoms. Revision total hip arthroplasty had been necessary due to a septic osteonecrosis of the femoral head 2 years after osteosynthesis of a traumatic proximal femur fracture with a sliding hip screw. The positive sample was taken out of the greater trochanter in the area of the possible former entry point for the lag screw, which was macroscopic inconspicuous. Sero-analysis could afterwards confirm the suspected diagnosis. Postoperative chemotherapy with albendazole was performed for 6 months. A full-body MRI did not reveal any further cysts. This case demonstrates a possible impact of migration on the expected pathogens in revision arthroplasty. This demonstrates that in revision arthroplasty, an infection with this parasite also has to be taken into account, if the patients come from an area endemic for hydatidosis.


Assuntos
Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Artroplastia de Quadril , Doenças Ósseas/diagnóstico , Equinococose/diagnóstico , Reoperação , Adolescente , Argélia , Doenças Ósseas/parasitologia , Doenças Ósseas/cirurgia , Equinococose/parasitologia , Equinococose/cirurgia , Fêmur/lesões , Fêmur/parasitologia , Alemanha , Humanos , Masculino , Resultado do Tratamento
19.
Int Orthop ; 43(1): 123-132, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30467646

RESUMO

BACKGROUND: The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. METHODS: We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves. RESULTS: At a mean follow-up of 13.7 months (range, 6-26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. CONCLUSION: 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term.


Assuntos
Artroplastia de Quadril , Doenças Ósseas/cirurgia , Neoplasias Ósseas/cirurgia , Reabsorção Óssea/cirurgia , Artropatias/cirurgia , Impressão Tridimensional , Adolescente , Adulto , Idoso , Artroplastia de Quadril/efeitos adversos , Doenças Ósseas/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Reabsorção Óssea/diagnóstico por imagem , Criança , Estudos de Viabilidade , Feminino , Humanos , Artropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
Foot Ankle Int ; 40(3): 323-329, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30379095

RESUMO

BACKGROUND:: Large osteochondral lesions of the talus (OLT) with good articular cartilage can be fixed by using bioabsorbable pins. These pins have various advantages but they can have adverse effects such as foreign body inflammation. This negative impact of pins on subchondral bone can be seen as bone marrow edema (BME) on magnetic resonance imaging (MRI). The purpose of this study was to investigate the course of change in BME on MRI, including osteolytic change around pins in OLT treated with pin fixation. METHODS:: This study comprised 13 ankles in 12 patients, who underwent surgeries to fix an OLT using poly-l-lactide acid pins. MRIs were taken at preoperative, 3, 6, and 12 months after surgery. The area of BME was measured at each time point, and osteolytic change around pins was evaluated. Moreover, pin insertion angle was measured. RESULTS:: BME significantly decreased from preoperative to 6 and 12 months. At 1 year, 28.1% of pins exhibited osteolytic change around them. Pin insertion angle was significantly lower in those with osteolytic change than those with no osteolytic change. At 3 and 6 months and 1 year postoperatively, BME with osteolytic change was significantly greater than those patients with no osteolytic change. The American Orthopaedic Foot & Ankle Society score significantly improved from preoperative (76.6±3.4 points) to 1 year after surgery (98.5±3.8 points). CONCLUSION:: A shallow pin insertion angle was associated with osteolytic change around pins and persistence of BME on MRI, although excellent results were obtained at 1 year after surgery. LEVEL OF EVIDENCE:: Level III, retrospective comparative series.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/cirurgia , Medula Óssea/diagnóstico por imagem , Pinos Ortopédicos/efeitos adversos , Edema/diagnóstico por imagem , Tálus/diagnóstico por imagem , Tálus/cirurgia , Implantes Absorvíveis/efeitos adversos , Adolescente , Adulto , Doenças Ósseas/patologia , Medula Óssea/patologia , Criança , Edema/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Medição da Dor , Estudos Retrospectivos , Tálus/patologia , Adulto Jovem
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