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1.
Bone Joint J ; 101-B(9): 1144-1150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474137

RESUMO

AIMS: The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. PATIENTS AND METHODS: Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. RESULTS: The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). CONCLUSION: Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.


Assuntos
Neoplasias Ósseas/cirurgia , Lâmina de Crescimento/cirurgia , Osteossarcoma/cirurgia , Próteses e Implantes , Adolescente , Criança , Feminino , Fêmur/cirurgia , Fixação Intramedular de Fraturas , Humanos , Úmero/cirurgia , Salvamento de Membro/métodos , Masculino , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação , Tíbia/cirurgia
2.
Bone Joint J ; 101-B(9): 1168-1176, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474141

RESUMO

AIMS: The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients. PATIENTS AND METHODS: A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications. RESULTS: The mean lengthening was 4.65 cm (1.5 to 8) in the antegrade group and 4.64 cm (1.6 to 8) in the retrograde group. Of the 107 lengthenings, 100 had sufficient datapoints to calculate the mean HI. This was 31.6 days/cm (15 to 108). There was a trend toward a lower (better) HI with an antegrade nail and better outcomes in adolescent patients, but these were not statistically significant. Hip and knee ROM was maintained and/or improved following commencement of femoral lengthening in 44 patients (60%) of antegrade nails and 13 patients (38%) of retrograde nails. In female patients, loss of movement occurred both earlier and following less total length achieved. Minor implant complications included locking bolt migration and in one patient deformity of the nail, but no implant failed to lengthen and there were no deep infections. Three patients had delayed union, five patients required surgical intervention for joint contracture. CONCLUSION: This study confirms excellent results in femoral lengthening with antegrade and retrograde Precice nails. There is a trend for better healing and less restriction in hip and knee movement following antegrade nails. There are clinical scenarios, that mandate the use of a retrograde nail. However, when these are not present, we recommend the use of antegrade nailing. Cite this article: Bone Joint J 2019;101-B:1168-1176.


Assuntos
Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Fêmur/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Adolescente , Adulto , Idoso , Alongamento Ósseo/métodos , Feminino , Humanos , Técnica de Ilizarov/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Niger J Clin Pract ; 22(9): 1276-1280, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489866

RESUMO

Aims: The present study aims to improve the design of cementless femoral prosthesis stem and achieve better bone ingrowth and long-term stability. Materials and Methods: Four models with different directional hollow holes at the proximal end of femoral prosthesis were designed and finite element analysis was applied to calculate the magnitude of conducting force within the differently angled holes and the stress distribution of the femur and prosthesis. Results: Holes in prostheses make no difference on the stress values of femoral inner walls. The conducting forces in models trepanned on the lateral plane were 6.60N (0° pore) and 8.40N (45° pore) while forces in models trepanned on the anterior-posterior planes were 0.45N (upper 0° pore), 0.48N (lower 0° pore) and 1.57N (upper 45° pore), 1.51N (lower 45° pore), respectively. Conclusion: The position and direction of hollow holes influenced the conducting force in holes but had no influence on stress values of femoral inner walls. Prostheses with one 45° hole trepanned on the lateral plane of proximal prostheses presented best in elevating conducting force.


Assuntos
Artroplastia de Quadril/instrumentação , Fêmur/cirurgia , Análise de Elementos Finitos , Prótese de Quadril , Imagem Tridimensional/métodos , Desenho de Prótese/métodos , Artroplastia de Quadril/métodos , Fêmur/diagnóstico por imagem , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Porosidade , Desenho de Prótese/normas , Estresse Mecânico , Tomografia Computadorizada Espiral
4.
J Surg Oncol ; 120(6): 994-1007, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31407350

RESUMO

BACKGROUND AND OBJECTIVES: Large scale data on the treatment of pathologic proximal femur fractures (PPFFs) are lacking. The purpose of this study was to evaluate trends in patient demographics, complication rates, and relative utilization rates of various techniques associated with PPFFs. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database was queried for PPFFs from 2009 to 2017. Patient demographics, 30-day complications, and utilization rates were recorded. Trends in these variables were determined over the study period. RESULTS: Most patient demographics did not change during the study period. There were no trends toward decreasing rates of major complications (P = .82), reoperations (P = .65), non-home discharges (P = .17), readmissions (P = .07), or deaths (P = .75); transfusion rates significantly decreased (P < .001). Rates of hemiarthroplasty decreased (P = .03) and rates of intramedullary nailing increased (P = .001). DISCUSSION: Despite advances in cancer therapeutics, the average PPFF patient has not significantly changed over the past decade. Similarly, most short-term outcomes after PPFF surgery have not improved, demonstrating a need for improved perioperative protocols. Finally, rates of IMN fixation are increasing while rates of HA are falling at NSQIP hospitals. Given that orthopedic oncologists favor endoprosthetic reconstruction in most cases, there may be a need for increased communication between orthopedic oncologists and other members of the orthopedic community treating PPFFs.


Assuntos
Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Ortopedia/tendências , Complicações Pós-Operatórias , Idoso , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/patologia , Fêmur/patologia , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Estados Unidos/epidemiologia
5.
Acta Cir Bras ; 34(6): e201900601, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432992

RESUMO

PURPOSE: To evaluate PBS®MCIMMO cement in the filling of bone defects. METHODS: Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. RESULTS: In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). CONCLUSION: The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Cimentos para Ossos , Regeneração Óssea/fisiologia , Substitutos Ósseos/administração & dosagem , Cerâmica , Fêmur/cirurgia , Teste de Materiais , Animais , Estudos Longitudinais , Masculino , Modelos Animais , Estudos Prospectivos , Ratos , Ratos Wistar
6.
J Pediatr Orthop ; 39(7): 339-346, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305376

RESUMO

BACKGROUND: Recent studies have demonstrated the intra-articular cartilage and labral damage that can occur from the proximal femoral cam-like deformity of a moderate to severe slipped capital femoral epiphysis (SCFE). The approach to treating this deformity in a symptomatic Loder stable hip is controversial. The purpose of this study was to compare radiographic outcomes, complication rates, and revision rates between Imhauser type triplane proximal femoral osteotomy (TPFO) and the modified Dunn procedure (MDP). METHODS: Twenty-six subjects with minimum 1-year follow-up were included (12 treated with a TPFO, and 14 treated with the MDP). A chart review was performed to capture data related to complications, revision procedures, surgical time, and body mass index. Radiographs were measured preoperatively and at final follow-up to evaluate epiphyseal-slip angle, neck-shaft angle, articular surface to trochanter distance, and medial proximal femoral angle. RESULTS: Surgical time was shorter for the TPFO group (150.0±57.4 min) compared with the MDP group (203.8±30 min) (P=0.005). All preoperative and postoperative radiographic measures were similar between the 2 groups except postoperative neck-shaft angle, which was significantly less in the TPFO group (129.7±8.6 vs. 140.9±9.4 degrees) (P=0.005). There were no cases of femoral head avascular necrosis (AVN) in the TPFO group. The modified Dunn group had a 29% AVN rate (P=0.1). The overall complication rate was similar between the TPFO (33%) and modified Dunn (36%) groups (P=1.0) and the reoperation rate was slightly greater in the TPFO group (33%) as compared with the modified Dunn group (21%) (P=0.67). CONCLUSIONS: The complex 3-dimensional proximal femoral deformity of a moderate to severe SCFE can be difficult to treat with relatively high complication/reoperation rates observed in both TPFO and MDP groups. All 4 instances of AVN in this study of stable slips, however, were in the MDP group. As this can be a devastating complication leading to early total hip arthroplasty, we advise against the MDP in stable SCFE patients. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Fêmur/cirurgia , Osteotomia/métodos , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Adolescente , Cartilagem Articular , Criança , Feminino , Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur , Humanos , Masculino , Duração da Cirurgia , Período Pós-Operatório , Radiografia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem , Resultado do Tratamento
7.
Pan Afr Med J ; 32: 191, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312303

RESUMO

Several surgical procedures, including mosaic arthroplasty, can be used to treat patients with cartilage loss in the femoral condyles. This study aims to assess mid-term clinical and radiological results as well as the main prognostics elements. We conducted a retrospective epidemiological study over a period of 15 years. During the study period we collected data from 35 workable medical records of patients with osteochondritis dissecans of the femoral condyles treated by mosaic arthroplasty, with an average follow-up of 24 months. The level of complaints as well as preoperative knee function were evaluated and compared with the healthy knee according to the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS). It was less than 60% in 27 patients. During the follow-up period, the results were analyzed according to Hughston's functional and radiological criteria. After an average follow-up of 24 months, algoneurodystrophy was reported in 5 cases with a single case of haemarthrosis. A net ICRS score improvement was observed with a mean increasing from 54% to 74% on the follow-up visit. Most of patients were satisfied or very satisfied (82.9%). The elements of good prognosis recognized in our study included: a mean time between symptom onset and surgery of less of 18 months, having deep lesions with a diameter less than 02 cm and having lesions in the internal condyle. The treatment of cartilage loss is necessarily based on the correction of its direct and indirect causes namely the morphotype, the laxity and meniscus capital. No consensus in the decision-making was reached and no one could confirm the superiority of a technique in relation to the other but we can say that cartilage defect which sizes from 2 to 4 cm² may be the best indication for mosaic arthroplasty.


Assuntos
Artroplastia/métodos , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteocondrite Dissecante/cirurgia , Adolescente , Adulto , Cartilagem Articular/patologia , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/patologia , Satisfação do Paciente , Prognóstico , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Pediatr Orthop ; 39(6): 282-288, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169747

RESUMO

BACKGROUND: Coxa vara has been frequently reported in spondyloepiphyseal dysplasia congenita (SEDC), and proximal femoral osteotomy has been described as a useful treatment. The aim of this study was to discuss the clinical, radiographic, and gait outcomes after valgus extension osteotomy of the proximal femur. Changes of lumbar lordosis, associated with coxa vara correction, are reported as well as the outcome differences between different ages. METHODS: Records of children with SEDC, who were followed at our institution between 2004 and 2014, were reviewed; and children had hip surgery were identified. Hip pain and passive range of motion, radiographic neck shaft angle (NSA), and Hilgenreiner trochanteric (H-T) angle, sagittal spinopelvic parameters, and gait data were recorded. Preoperative and last follow-up data were compared. Outcomes were also compared between 3 age groups. RESULTS: Of the 79 children with SEDC, 26 children (12 boys and 14 girls) had hip osteotomy in 48 hips. Mean age at surgery was 9.6 years and the mean follow-up was 5 years. Preoperative hip pain was noted in 30 hips. At the last follow-up, 3 hips were painful at the extreme range of motion. Passive range of motion, NSA, and H-T improved postoperatively. Although NSA was maintained over the follow-up, H-T deterioration was noted. Spinopelvic measurements changed significantly and gait data remained stable except pelvic tilt that reduced significantly after surgery. The changes of radiographic measurements in each age group were similar to the total group of patients. CONCLUSIONS: In children with SEDC, surgical correction of coxa vara, by proximal femoral valgus osteotomy, is an effective treatment that improves hip pain and range of motion in addition to the radiographic alignment of the proximal femur and the sagittal spinopelvic alignment. Children are expected to maintain their level of function after surgery and to have good results over the midterm regardless of their age at surgery. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Osteocondrodisplasias/congênito , Osteotomia/métodos , Adolescente , Criança , Pré-Escolar , Coxa Vara/cirurgia , Feminino , Fêmur/cirurgia , Seguimentos , Marcha/fisiologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/fisiopatologia , Osteocondrodisplasias/cirurgia , Radiografia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
9.
Orthopade ; 48(7): 555-562, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31190111

RESUMO

Improvements in diagnostics and effectiveness of chemotherapy have resulted in most patients with primary malignant bone tumours being candidates for limb salvage surgery. Herewith, the use of modern modular tumour endoprostheses allows for the replacement of all big joints and even entire long bones such as the femur, humerus and tibia. In this article, we focus on individual prerequisites for and challenges with performing a total endoprosthetic reconstruction of the above-mentioned anatomic structures. Additionally, data from the literature with regards to functional outcome, problems and complications are presented.


Assuntos
Neoplasias Ósseas , Tíbia , Neoplasias Ósseas/cirurgia , Fêmur/cirurgia , Humanos , Úmero/cirurgia , Salvamento de Membro , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(25): e16140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232968

RESUMO

The aim of this study was to clinically compare the therapeutic effects of internal fixation using a third-generation Gamma Long Nail (TGLN) with that of INTERTAN in the treatment of Seinsheimer Type V subtrochanteric femoral fractures in elderly patients.The therapeutic effect of internal fixation with TGLN, compared with that with INTERTAN, was retrospectively analyzed in elderly patients diagnosed with Seinsheimer Type V subtrochanteric fracture. Twenty-five cases were divided into 2 groups based on the fixation devices: the TGLN group (13 cases; 5 men and 8 women) and the INTERTAN group (12 cases; 5 men and 7 women). Patients were followed up postoperatively, and their clinical history, intraoperative blood loss, fracture healing, Harris Hip Scores, and postoperative complications were recorded and compared.Patients in the TGLN group had shorter operation time and less intraoperative blood loss, compared with those in the INTERTAN group (P < .05). There were no significant between-group differences in postoperative complications, fracture healing time and Harris Hip Scores during the follow-up (P > .05).


Assuntos
Pinos Ortopédicos/normas , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos/estatística & dados numéricos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/epidemiologia , Fêmur/diagnóstico por imagem , Fêmur/lesões , Geriatria/métodos , Geriatria/normas , Humanos , Fixadores Internos/normas , Fixadores Internos/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 98(25): e16152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232970

RESUMO

To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non-elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo/normas , Fixação Intramedular de Fraturas/normas , Pinos Ortopédicos/normas , Pinos Ortopédicos/estatística & dados numéricos , Transplante Ósseo/métodos , Transplante Ósseo/estatística & dados numéricos , Criança , Curetagem/métodos , Feminino , Fêmur/anormalidades , Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Humanos , Úmero/anormalidades , Úmero/cirurgia , Masculino , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento
13.
Bone Joint J ; 101-B(6): 660-666, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154844

RESUMO

AIMS: There is little literature about total knee arthroplasty (TKA) after distal femoral osteotomy (DFO). Consequently, the purpose of this study was to analyze the outcomes of TKA after DFO, with particular emphasis on: survivorship free from aseptic loosening, revision, or any re-operation; complications; radiological results; and clinical outcome. PATIENTS AND METHODS: We retrospectively reviewed 29 patients (17 women, 12 men) from our total joint registry who had undergone 31 cemented TKAs after a DFO between 2000 and 2012. Their mean age at TKA was 51 years (22 to 76) and their mean body mass index 32 kg/m2 (20 to 45). The mean time between DFO and TKA was ten years (2 to 20). The mean follow-up from TKA was ten years (2 to 16). The prostheses were posterior-stabilized in 77%, varus-valgus constraint (VVC) in 13%, and cruciate-retaining in 10%. While no patient had metaphyseal fixation (e.g. cones or sleeves), 16% needed a femoral stem. RESULTS: The ten-year survivorship was 95% with aseptic loosening as the endpoint, 88% with revision for any reason as the endpoint, and 81% with re-operation for any reason as the endpoint. Three TKAs were revised for instability (n = 2) and aseptic tibial loosening (n = 1). No femoral component was revised for aseptic loosening. Patients under the age of 50 years were at greater risk of revision for any reason (hazard ratio 7; p = 0.03). There were two additional re-operations (6%) and four complications (13%), including three manipulations under anaesthetic (MUA; 10%). The Knee Society scores improved from a mean of 50 preoperatively (32 to 68) to a mean of 93 postoperatively (76 to 100; p < 0.001). CONCLUSION: A cemented posterior-stabilized TKA has an 88% ten-year survivorship with revision for any reason as the endpoint. No femoral component was revised for aseptic loosening. Patients under the age of 50 years have a greater risk of revision. The clinical outcome was significantly improved but balancing the knee was challenging in 13% of TKAs requiring VVC. Overall, 10% of TKAs needed an MUA, and 6% of TKAs were revised for instability. Cite this article: Bone Joint J 2019;101-B:660-666.


Assuntos
Artroplastia do Joelho/métodos , Fêmur/cirurgia , Osteotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida
14.
Ann R Coll Surg Engl ; 101(6): e133-e135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155900

RESUMO

We present a case of symptomatic trochanteric non-union following total hip replacement treated initially with a Dall-Miles grip plate. After failure of this treatment, the patient had a two-stage revision. Trochanteric non-union is one of the well-described complications after total hip replacement. It is frequently difficult to treat, while potentially causing weakness, altered gait and instability of the artificial joint. We believe that reattachment of the trochanter combined with a staged revision of the femoral stem using a posterior approach for the second stage could be a valuable technique to be added to the orthopaedic armamentarium for recurrent and symptomatic trochanteric non-unions after primary total hip replacement, particularly after failure to treat with all the other techniques described in literature.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fêmur/cirurgia , Reoperação/métodos , Artroplastia de Quadril/métodos , Feminino , Prótese de Quadril , Humanos , Pessoa de Meia-Idade , Falha de Prótese
15.
Nanomedicine (Lond) ; 14(9): 1109-1133, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31050592

RESUMO

Aim: To improve the bioactivity and antibacterial activity of titanium (Ti) implants. Materials & methods: Magnesium (Mg)-doped titanium dioxide microporous coatings (Mg-TiO2) were prepared on the surface of Ti implants by plasma electrolytic oxidation. Results: Ti surfaces were covered with porous Mg-TiO2, and Mg was evenly distributed throughout the coating. Mg-TiO2 could not only promote osteoblast adhesion, proliferation and differentiation but also inhibit the colonization and growth of Staphylococcus. In addition, Mg-TiO2 may promote osteogenesis through the ERK/c-Fos signaling pathway as well as the early osseointegration of Ti implants. Conclusion: Mg-TiO2 has both osteogenic and antibacterial effects and thus presents important theoretical significance and clinical potential.


Assuntos
Antibacterianos/farmacologia , Magnésio/química , Osteogênese/efeitos dos fármacos , Titânio/química , Animais , Interface Osso-Implante , Adesão Celular , Diferenciação Celular , Linhagem Celular , Proliferação de Células , Materiais Revestidos Biocompatíveis , Fêmur/cirurgia , Humanos , Camundongos , Osseointegração , Osteoblastos/citologia , Porosidade , Próteses e Implantes , Coelhos , Staphylococcus/efeitos dos fármacos
16.
Surg Technol Int ; 34: 503-510, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037720

RESUMO

BACKGROUND: The use of the direct anterior approach has been criticized as a significant risk factor for subsidence, perioperative fracture, and thigh pain. Therefore, the purpose of our study was to evaluate the outcome of using the center-center technique via the direct anterior approach. MATERIALS AND METHODS: Consecutive elective primary total hip arthroplasties performed using the center-center technique were retrospectively reviewed from May 2015 to February 2017. All cases were performed by a single surgeon at a high-volume, large academic center. The technique focuses on central alignment of the implant on both anteroposterior and lateral radiographs. Standardized objective radiographic measurements were taken at the first two-week follow-up visit to determine the fit and fill at the proximal and distal anatomic segments. Subsidence was measured by comparing the implant position at final follow up to the initial two-week postoperative visit. Other complications: intra- or postoperative fracture, infection, revision, and patient-reported thigh pain were further assessed. Functional postoperative outcomes were assessed using the Harris Hip Score (HHS). RESULTS: A total of 138 patients with a mean age of 65 years and average follow up of 2.8 years were assessed. The mean postoperative HHS was 90 points (59-100). Mean implant subsidence was 1mm. A total of 90% (124) of implants had acceptable radiographic fit and fill in both proximal and distal segments. A majority 74% (102) of implants subsided less than 1mm, and 91% (126) subsided less than 2mm. One implant had radiographic subsidence of 9mm, which was treated with a shoe lift. There were no intraoperative fractures. One postoperative lateral cortex fracture three weeks after surgery due to mechanical fall was treated conservatively. No patients required revision arthroplasty for any reason or reported postoperative thigh pain. CONCLUSION: The center-center technique can be used to consistently aid in proper femoral stem placement in both coronal and sagittal planes. Optimal fit and fill can be achieved safely using this technique.


Assuntos
Artroplastia de Quadril/métodos , Fêmur/cirurgia , Prótese de Quadril , Idoso , Humanos , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
17.
Bone Joint J ; 101-B(5): 522-528, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31038993

RESUMO

AIMS: The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR). PATIENTS AND METHODS: In all, 81 patients treated with TFEPR from 1976 to 2017 were retrospectively evaluated and failures were categorized according to the Henderson classification. There were 38 female patients (47%) and 43 male patients (53%) with a mean age at diagnosis of 43 years (12 to 86). The mean follow-up time was 10.3 years (0 to 31.7). A survival analysis was performed followed by univariate and multivariate Cox regression to identify independent implant survival factors. RESULTS: The revision-free survival of the implant was 71% at five years and 63.3% at ten years. Three prostheses reached 15 years without revision. The mean Musculoskeletal Tumor Society score in the group was 26 (23 to 28). The mechanisms of failure were infection in 18%, structural failures in 6%, tumour progression in 5%, aseptic loosening in 2%, and soft-tissue failures in 1%. Prostheses used for primary reconstruction after oncological resections had lower infection rates than revision implants (8% vs 25%; p = 0.001). The rates of infection in silver-coated and non-silver-coated prosthesis were similar (17.4% vs 19.%; p = 0.869). The incidence of hip dislocation was 10%. Rotating hinge prosthesis had a lower failure rate than fixed hinge prosthesis (5.3% vs 11%). After Cox regression, the independent factors associated with failures were the history of previous operations (hazard ratio (HR) 3.7; p = 0.041), and the associated arthroplasty of the proximal tibia (HR 3.8; p = 0.034). At last follow-up, 11 patients (13%) required amputation. CONCLUSION: TFEPR offers a reliable reconstruction option for massive bone loss of the femur, with a good survival when the prosthesis is used as a primary implant. The use of a rotating hinge at the knee and dual mobility bearing at the hip may be adequate to reduce the risk of mechanical and soft-tissue failures. Infection remains the main concern and there is insufficient evidence to support the routine use of silver-coated endoprosthesis. Cite this article: Bone Joint J 2019;101-B:522-528.


Assuntos
Neoplasias Ósseas/cirurgia , Fêmur/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Falha de Prótese/etiologia , Reoperação/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Fêmur/patologia , Humanos , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Falha de Prótese/efeitos adversos , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
18.
Clin Sports Med ; 38(3): 351-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079767

RESUMO

Distal femoral osteotomy (DFO) is a valid option for the treatment of young and active patients with lateral compartment osteoarthritis/overload and valgus malalignment. DFOs can be performed with a closing wedge or opening wedge technique. Lateral opening wedge DFO is usually preferred for smaller corrections, whereas medial closing wedge for larger corrections and in patients with high risk of nonunion. This article describes the relevant aspects regarding lateral opening wedge DFO, including patient selection, preoperative planning, surgical technique, results, and complications.


Assuntos
Fêmur/cirurgia , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Período Pré-Operatório , Radiografia
19.
Clin Sports Med ; 38(3): 361-373, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079768

RESUMO

The main indication for performing a distal femoral osteotomy is valgus malalignment of the knee joint. The ideal candidates are young and active individuals with isolated lateral compartment arthritis. The goal of the procedure is to create a neutral mechanical axis of the limb to relieve pain and preserve the knee joint. The amount of correction is calculated from a preoperative, high-quality, weight-bearing radiograph from the hip to ankle. This technically challenging operation is a viable option for patients with valgus malalignment because early survivorship is strong and patient-reported outcome scores are significantly improved.


Assuntos
Fêmur/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Período Pré-Operatório , Radiografia
20.
Clin Sports Med ; 38(3): 387-399, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079770

RESUMO

Distal femoral varus-producing osteotomy can be performed in the setting of lateral meniscal transplant to correct valgus malalignment of the knee and thus offload the lateral compartment. Advantages of a lateral opening wedge over medial closing wedge osteotomy include a single bone cut, avoidance of vascular structures, and theoretically better control of the amount of correction. It is important to address all knee joint comorbidities, including meniscal deficiency, chondral and osteochondral defects, and ligamentous insufficiency. This article reviews indications, preoperative considerations, technique, postoperative rehabilitative protocol, and results in the literature associated with concurrent varus-producing distal femoral osteotomy and lateral meniscal transplant.


Assuntos
Fêmur/cirurgia , Meniscos Tibiais/transplante , Osteotomia/métodos , Aloenxertos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Exame Físico , Radiografia
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