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1.
Rev Med Liege ; 76(4): 262-267, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33830690

RESUMO

Rotationplasty can be used as an alternative to amputation when conservative treatment is not possible, for example in malignant tumours of the knee. The principle of the operation is to rotate the lower leg through 180 ° after resection of the distal femur and in this way the ankle joint replaces the knee joint. This surgical technique, although complex, allows satisfactory carcinological resection with a functional outcome superior to amputation above the knee as well as a better quality-of-life. Patients do not develop phantom pain, neuroma or stump discomfort because it is not an amputation. In addition, they can actively control their knee and having proprioception and normal contact with the ground. This results in a coordinated, harmonious and elegant gait pattern similar to the normal population. Patients are more efficient in their activities of everyday life and sports. The major disadvantage is the particular aesthetic aspect and the psychological acceptance.


Assuntos
Artroplastia do Joelho , Neoplasias Ósseas , Amputação , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Rotação
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 409-413, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855822

RESUMO

Objective: To simulate and validate the performance, accuracy, and safety of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through cadaver-based experiment, thus optimizing the robotic system for the future human clinical application. Methods: Six unilateral adult cadaver specimens of the lower limbs were scanned by three-dimensional CT before the experiment, and then the three-dimensional models of femur and tibia were obtained by using the preoperative software of YUANHUA-TKA system, so as to plan the type of prosthesis implant, the osteotomy volume and osteotomy angles [hip-knee-ankle angle (HKA), coronal frontal femoral component (FFC) and frontal tibial component (FTC)], the ideal value of HKA was set to 180°, and of FFC and FTC were set to 90°, respectively. The operator could further confirm the osteotomy plan according to the intraoperative situation before osteotomy, and then install the prosthesis after completing the osteotomy in each plane with the assistance of YUANHUA-TKA system. At last, the X-ray films of hip joint, knee joint, and ankle joint were taken and stitched into the full length X-ray film of the lower limb, and HKA, coronal FFC and FTC were measured. Results: During the experiment, YUANHUA-TKA system ran stably. All sections of femur and tibia were smooth and no ligament injury was found. After operation, the HKA was 177.1°-179.7°, FFC was 87.9°-91.4°, and FTC was 87.3°-91.4°, which were within ±3° from the ideal values of preoperative planning. Conclusion: The YUANHUA-TKA system can assist the surgeon to carry out precise osteotomy according to the preoperative planned value, which has a good auxiliary effect for total knee arthroplasty. It is expected to assist joint surgeons to improve the surgical accuracy in clinical application.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Robótica , Adulto , Cadáver , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia
3.
Orthop Clin North Am ; 52(2): 111-121, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33752832

RESUMO

Periarticular fractures of the lower extremity can be difficult injuries to stabilize effectively. Modern advances in technique and implant design now allow many of these fractures to be fixed with an extreme intramedullary nail. When nailing is not possible, less invasive plating through percutaneous incisions is a reliable option. The decision to perform extreme nailing is multifactorial and is based on the fracture pattern, the condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weightbearing.


Assuntos
Fêmur/lesões , Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fixadores Internos , Fraturas da Tíbia/cirurgia , Fixação Intramedular de Fraturas/métodos , Humanos
4.
Orthopade ; 50(4): 287-295, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33751196

RESUMO

BACKGROUND: The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION: Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril , Procedimentos Cirúrgicos Reconstrutivos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia
5.
Niger J Clin Pract ; 24(3): 369-379, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33723111

RESUMO

Background: Proximal femoral geometry(PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. There are variations in these parameters. Ethnicity is one of the most influential factors accounting for these variations. Aim: To determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical application in total hip replacement and other hip surgeries. Materials and Method: Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and proximal femoral parameters measured using Vernier calipers. Results: There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M=19.04°, SD=2.075°, Proximal Femoral Length(PFL): M=73.24mm,SD=7.622, Femoral Head Vertical Diameter(FHVD):M= 44.64mm, SD=3.134, Femoral Head Transverse Diameter(FHTD),M=44.55mm, SD=3.379mm, Femoral Head Diameter(FHD),M=44.60mm, SD=3.119mm, Femoral Neck Anterior Length(FNAL), M=31.86mm, SD=5.383mm, Femoral Posterior Neck Length(FPNL):M=22.23mm, SD=3.520mm, Femoral Neck Diameter (FND), M=32.71mm,SD= 3.315mm, Proximal Femoral Width Head to Side (PFWHS), M=89mm.80,SD= 10.331mm, Proximal Femoral Width Side to Side (PFWSS), M=31.47mm, SD=2.812mm, Femoral Neck Shaft Angle(FNSA), M=132.15°, 7.305°. Conclusion: The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, differed from other populations and exhibited laterality.


Assuntos
Artroplastia de Quadril , Fenômenos Biomecânicos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Colo do Fêmur/cirurgia , Humanos , Nigéria
6.
Bone Joint J ; 103-B(3): 456-461, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641428

RESUMO

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.


Assuntos
Transplante Ósseo/métodos , Fosfatos de Cálcio/farmacologia , Fêmur/cirurgia , Ílio/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Adulto , Artrodese , Desbridamento , Feminino , Fêmur/lesões , Fêmur/patologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato , Estudos Retrospectivos , Tíbia/lesões , Tíbia/patologia , Cicatrização/efeitos dos fármacos
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 188-194, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624472

RESUMO

Objective: To discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty (TKA) based on knee CT and full-length X-ray film of lower extremities. Methods: Between July 2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females; aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m 2, with an average of 24.8 kg/m 2. The preoperative range of motion (ROM) of the knee joint was (103.0±19.4)°, the pain visual analogue scale (VAS) score was 5.4±1.3, and the American Hospital of Special Surgery (HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation. The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle (FMAA), anatomical lateral distal femoral angle (aLDFA), mechanical femoral tibial angle (mFTA), distal femoral flexion angle (DFFA), femoral prosthesis flexion angle (FPFA), anatomical lateral femoral component angle (aLFC), and the angle of the femoral component and femoral shaft (α angle) between pre- and post-operation. Results: TKA was successfully completed with the aid of the distal femoral patient-specific cutting guide. There was no significant difference between the thickness of the internal and lateral condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy ( P>0.05). All patients were followed up 3 months. All incisions healed by first intention, and there was no complications such as periarticular infection and deep vein thrombosis. Except for 1 patient who was not treated with tranexamic acid, the intraoperative blood loss of the rest 19 patients ranged from 30 to 150 mL, with an average of 73.2 mL; the postoperative drainage loss ranged from 20 to 500 mL, with an average of 154.5 mL; and the hidden blood loss ranged from 169.2 to 1 400.0 mL, with an average of 643.8 mL. At 3 months after operation, the ROM of the knee was (111.5±11.5)°, and there was no significant difference when compared with the preoperative one ( t=-1.962, P=0.065). The VAS score was 2.4±0.9 and HSS score was 88.2±7.5, showing significant differences when compared with the preoperative ones ( t=7.248, P=0.000; t=-11.442, P=0.000). Compared with the preoperative measurements, there was a significant difference in mFTA ( P<0.05), and there was no significant difference in aLDFA, FMAA, or DFFA; compared with the preoperative plan, there was no significant difference in FPFA, aLFC, or α angle ( P>0.05). Conclusion: The use of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremity can achieve precise osteotomy, improve coronal and sagittal limb alignment, reduce intraoperative blood loss, and obtain satisfactory short-term effectiveness.


Assuntos
Articulação do Joelho , Filme para Raios X , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 258-264, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624484

RESUMO

Objective: To review the research progress of location methods and the best femoral insertion position of medial patellofemoral ligament (MPFL) reconstruction of femoral tunnel, and provide reference for surgical treatment. Methods: The literature about femoral insertion position of the MPFL reconstruction in recent years was extensively reviewed, and the anatomical and biomechanical characteristics of MPFL, as well as the advantages and disadvantages of femoral tunnel positioning methods were summarized. Results: The accurate establishment of the femoral anatomical tunnel is crucial to the success of MPFL reconstruction. At present, there are mainly two kinds of methods for femoral insertion: radiographic landmark positioning method and anatomical landmark positioning method. Radiographic landmark positioning method has such advantages as small incision and simple operation, but it can not be accurately positioned for patients with severe femoral trochlear dysplasia. It is suggested to combine with the anatomical landmark positioning method. These methods have their own advantages and disadvantages, and there is no unified positioning standard. In recent years, the use of three-dimensional design software can accurately assist in the MPFL reconstruction, which has become a new trend. Conclusion: Femoral tunnel positioning of the MPFL reconstruction is very important. The current positioning methods have their own advantages and disadvantages. Personalized positioning is a new trend and has not been widely used in clinic, its effectiveness needs further research and clinical practice and verification.


Assuntos
Doenças Ósseas , Ferida Cirúrgica , Artéria Femoral , Fêmur/cirurgia , Humanos , Ligamentos Articulares/cirurgia
9.
Bone Joint J ; 103-B(2): 398-404, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517739

RESUMO

AIMS: We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur. METHODS: A total of 14 patients underwent primary or revision reconstruction of a large femoral defect with a short remaining proximal femur using an interlocking, reconstruction-mode stem-sideplate for fixation after oncological distal femoral and diaphyseal resections. The implant was attached to a standard endoprosthetic reconstruction system. The implant was attached to a standard endoprosthetic reconstruction system. None of the femoral revisions were amenable to standard cemented or uncemented stem fixation. Patient and disease characteristics, surgical history, final ambulatory status, and Musculoskeletal Tumor Society (MSTS) score were recorded. The percentage of proximal femur remaining was calculated from follow-up radiographs. RESULTS: All 14 at-risk native hip joints were preserved at a mean final follow-up of 6.0 years (SD 3.7), despite a short residual femur, often after proximal osteotomies through the lesser trochanter. Overall, 13 of 14 stems had long-term successful fixation. Eight patients required no reoperation. Three patients required reoperation due to implant-related issues, and three patients required reoperation for wound healing problems or infection. There were no dislocations or fractures. At final follow-up the mean MSTS score was 24.9 (SD 4.1). Nine patients required no ambulation aids, and only one had a Trendelenburg gait. CONCLUSION: This interlocking, reconstruction-mode stem-sideplate reliably preserves native hip joint anatomy and function after large femoral resection with a short remaining proximal femur, both in the primary and revision setting. This is particularly important for preventing or delaying total femoral arthroplasty in young patients after oncological reconstruction. Hip abductor strength and function could be maintained by this method, and the risk of dislocation eliminated. The success of this technique in this modest series should be verified in a larger collaborative study and will be of interest to revision surgeons and oncologists. Cite this article: Bone Joint J 2021;103-B(2):398-404.


Assuntos
Artroplastia de Quadril/instrumentação , Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Prótese de Quadril , Desenho de Prótese , Sarcoma/cirurgia , Adulto , Artroplastia de Quadril/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
10.
Bone Joint J ; 103-B(2): 338-346, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517724

RESUMO

AIMS: This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. METHODS: Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. RESULTS: Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). CONCLUSION: Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338-346.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Feminino , Fêmur/patologia , Fêmur/fisiologia , Fêmur/cirurgia , Seguimentos , Hemiartroplastia/instrumentação , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Tíbia/patologia , Tíbia/fisiologia , Tíbia/cirurgia , Resultado do Tratamento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 118-123, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448209

RESUMO

Objective: To systematically review the progress of different methods for femoral tunnel positioning in anterior cruciate ligament (ACL) reconstruction and provide a clinical reference for treatment of ACL rupture. Methods: The literature about the femoral tunnel positioning in ACL reconstruction was widely reviewed. The advantages and disadvantages and the clinical results of each method were summarized. Results: Currently in ACL reconstruction, methods for femoral tunnel positioning include transtibial technique (TT), anteromedial technique (AM), outside-in (OI), modified TT (mTT), and computer assisted surgery. There is no significant difference in the postoperative effectiveness between TT technique and AM technique. Compared with the TT technique, the OI technique has higher rotational stability of knee, but there is no significant difference in clinical results. The femoral tunnel located by mTT technique is closer to the anatomical placement than that of TT technique, but mTT technique is not effective for systematically anatomic femoral tunnel positioning, and further research is needed to prove its advantages. Conclusion: Different femoral tunnel positioning methods have their own advantages and disadvantages, and there is no definite evidence that one is superior than the rest.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Tíbia/cirurgia
12.
Arthroscopy ; 37(1): 124-127, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384075

RESUMO

The abnormalities of femoral twist or version, whether increased anteversion or retroversion, are frequently overlooked. These skeletal aberrations are responsible for a host of hip problems such as impingement, instability and damage to the labrum and articular cartilage, often resulting in osteoarthritis if left untreated. In addition to the intrinsic hip damage, extra articular problems such as posterior hip impingement, pelvic tendonopathies, problems with gait and sitting as well as spinal decompensation are also very common. It is incumbent upon those who manage hip problems to be aware of the damage caused by femoral version abnormalities and the treatment options available.


Assuntos
Cartilagem Articular , Articulação do Quadril , Fêmur/cirurgia , Humanos , Osteotomia , Amplitude de Movimento Articular
13.
Arthroscopy ; 37(1): 338-339, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384091

RESUMO

Optimal femoral anterior cruciate ligament graft placement has been extensively studied. The champions of transtibial reconstruction debate the backers of anteromedial portal and outside-in drilling. The holy grail is footprint restoration and how we best to get there. To me, creating the femur independently provides the best chance of finding that footprint by being unconstrained by the tibia. Anterior cruciate ligament surgery is challenging enough; decrease intraoperative stress and increase your likelihood of femoral footprint restoration by drilling it though the anteromedial portal.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tíbia/cirurgia
14.
Sports Med Arthrosc Rev ; 29(1): 28-34, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395228

RESUMO

Femoral version is extremely variable between patients presenting with femoroacetabular impingement (FAI). Careful and routine measurement of femoral anteversion is essential in comprehensive preoperative planning. In general, low degrees of femoral version can lead to anterior impingement (especially on the subspine and distal medial femoral neck). High degrees of anteversion can be seen in the setting of acetabular dysplasia and can lead to anterior hip instability and or posterior impingement. In this article, the authors will discuss the role of routine femoral version management for optimal outcomes after hip arthroscopy for FAI.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/fisiopatologia , Impacto Femoroacetabular/cirurgia , Fêmur/fisiopatologia , Articulação do Quadril/fisiopatologia , Impacto Femoroacetabular/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Exame Físico , Radiografia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
15.
BMC Surg ; 21(1): 9, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407340

RESUMO

BACKGROUND: This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). METHODS: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9-6.1 years). RESULTS: The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22-38) to 87.5 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4-9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6-67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2-53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. CONCLUSIONS: THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.


Assuntos
Artroplastia de Quadril , Luxação Congênita de Quadril , Adulto , Idoso , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Estudos Retrospectivos
16.
Z Orthop Unfall ; 159(1): 98-100, 2021 02.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33336331

RESUMO

Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Anormalidade Torcional/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Reoperação , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologia
17.
J Periodontal Res ; 56(2): 351-362, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33368275

RESUMO

OBJECTIVE: Using a mouse osteoporotic model, this study aimed to determine the influence of hydrophilic titanium surfaces on gene expression and bone formation during the osseointegration process. BACKGROUND: Based on the previous evidence, it is plausible to assume that osteoporotic bone has a different potential of bone healing. Therefore, implant surface modification study that aims at enhancing bone formation to further improve short- and long-term clinical outcomes in osteoporosis is necessary. MATERIAL AND METHODS: Fifty female, 3-month-old mice were included in this study. Osteoporosis was induced by ovariectomy (OVX, test group) in 25 mice. The further 25 mice had ovaries exposed but not removed (SHAM, control group). Seven weeks following the ovariectomy procedures, one customized implant (0.7 × 8 mm) of each surface was placed in each femur for both groups. Implants had either a hydrophobic surface (SAE) or a hydrophilic treatment surface (SAE-HD). Calcium (Ca) and phosphorus (P) content was measured by energy-dispersive X-ray spectroscopy (EDS) after 7 days. The femurs were analyzed for bone-to-implant contact (BIC) and bone volume fraction (BV) by nano-computed tomography (nano-CT) after 14 and 28 days. Same specimens were further submitted to histological analysis. Additionally, after 3 and 7 days, implants were removed and cells were collected around the implant to access gene expression profile of key osteogenic (Runx2, Alp, Sp7, Bsp, Sost, Ocn) and inflammatory genes (IL-1ß, IL-10, Tnf-α, and Nos2) by qRT-PCR assay. Statistical analysis was performed by ANOVA and paired t test with significance at P < .05. RESULTS: The amount of Ca and P deposited on the surface due to the mineralization process was higher for SAE-HD compared to SAE on the intra-group analysis. Nano-CT and histology revealed more BV and BIC for SAE-HD in SHAM and OVX groups compared to SAE. Analysis in OVX group showed that most genes (ie, ALP, Runx2) involved in the bone morphogenetic protein (BMP) signaling were significantly activated in the hydrophilic treatment. CONCLUSION: Both surfaces were able to modulate bone responses toward osteoblast differentiation. SAE-HD presented a faster response in terms of bone formation and osteogenic gene expression compared to SAE. Hydrophilic surface in situations of osteoporosis seems to provide additional benefits in the early stages of osseointegration.


Assuntos
Implantes Dentários , Osteoporose , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Osseointegração , Osteoporose/genética , Ovariectomia , Propriedades de Superfície , Titânio
18.
Methods Mol Biol ; 2230: 75-89, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33197009

RESUMO

The shortcomings of autografts and allografts in bone defect healing have prompted researchers to develop suitable alternatives. Numerous biomaterials have been developed as bone graft substitutes each with their own advantages and disadvantages. However, in order to test if these biomaterials provide an adequate replacement of the clinical standard, a clinically representative animal model is needed to test their efficacy. In this chapter, we describe a mouse model that establishes a critical sized defect in the mid-diaphysis of the femur to evaluate the performance of bone graft substitutes. This is achieved by performing a femoral ostectomy and stabilization utilizing a femoral plate and titanium screws. The resulting defect enables the bone regenerative potential of bone graft substitutes to be investigated. Lastly, we provide instruction on assessing the torsional strength of the healed femurs to quantitatively evaluate the degree of healing as a primary outcome measure.


Assuntos
Materiais Biocompatíveis/farmacologia , Regeneração Óssea/efeitos dos fármacos , Transplante Ósseo/métodos , Diáfises/efeitos dos fármacos , Fêmur/cirurgia , Animais , Autoenxertos/transplante , Parafusos Ósseos , Substitutos Ósseos/farmacologia , Diáfises/crescimento & desenvolvimento , Modelos Animais de Doenças , Fêmur/crescimento & desenvolvimento , Fêmur/fisiopatologia , Consolidação da Fratura/efeitos dos fármacos , Humanos , Camundongos
19.
J Pediatr Orthop ; 41(1): e7-e13, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32804861

RESUMO

BACKGROUND: Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity. METHODS: Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed. Two patient (2 hips) were excluded due to insufficient follow-up. The average age at the time of surgery was 17.7 years (range: 13 to 28 y). We compared the preoperative to postoperative changes in radiographic parameters as well as early outcomes as measured by patient assessment of hip pain and function using the modified Harris Hip Score (mHHS). RESULTS: The average time of follow-up was 3.3 years (range: 2.0 to 6.3 y). Tönnis angles decreased from a median of 30 degrees (range: 18 to 45 degrees) preoperatively to a median of 6 degrees (range: -9 to 21 degrees) postoperatively. Lateral center-edge angles increased from a median of -8 degrees (range: -28 to 15 degrees) to a median of 32 degrees (range: 19 to 38 degrees). Anterior center-edge angles increased from a median of 2 degrees (range: -22 to 39 degrees) to a median of 35 degrees (range: 22 to 47 degrees). The extrusion index decreased from a median of 57% preoperatively (range: 35% to 73%) to a median of 21% (range: 11% to 36%) postoperatively.The median mHHS was 62 (range: 37 to 81) preoperatively and 85 (range: 65 to 100) postoperatively. Notably, the pain component of the mHHS improved from 20 (range: 0 to 44) to 42 (range: 30 to 44). Tönnis osteoarthritis grade preoperatively was either 0 (11 hips) or 1 (5 hips) and remained unchanged in 11 hips and increased by 1 grade in 5 hips. CONCLUSIONS: It has been our experience that the Bernese PAO in combination with appropriate adjunctive treatments has provided a very satisfactory surgical approach in the treatment of CP hip dysplasia. In the adolescent and young adult with spastic CP, utilizing the Bernese PAO technique makes it possible to obtain redirection of often a very severe acetabular dysplasia. Adjunctive soft tissue procedures and a proximal femoral osteotomy are frequently necessary to maintain postoperative stability. A notable improvement in the quality of life and function directly attributable to our surgical treatment of their pre-existing problematic hip dysplasia has been consistently noted in early follow-up for our patients. LEVEL OF EVIDENCE: Level IV-therapeutic.


Assuntos
Paralisia Cerebral/complicações , Fêmur/cirurgia , Luxação do Quadril/cirurgia , Osteotomia/métodos , Acetábulo/cirurgia , Adolescente , Adulto , Artralgia , Feminino , Luxação do Quadril/etiologia , Humanos , Masculino , Osteotomia/efeitos adversos , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
J Pediatr Orthop ; 41(1): e44-e49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32947442

RESUMO

BACKGROUND: Limb lengthening using intramedullary externally controlled motorized devices is becoming increasingly popular. There is limited literature regarding their use in the pediatric and adolescent population. This study reviews outcomes on 50 consecutive cases of intramedullary lower limb lengthening surgery in this population. METHODS: A retrospective review of all pediatric and adolescent patients treated in our institution by intramedullary lengthening for lower limb length discrepancy using the PRECICE and STRYDE intramedullary lengthening nails between 2013 and 2019. All patients were operated by a single surgeon. Data were prospectively recorded. We report on nail accuracy and reliability, consolidation index, time to full weight-bearing from completion of lengthening, joint range of movement, ASAMI bone and functional scores, presence of problems, obstacles and complications, and patient reported outcome measures (PROMS). RESULTS: Fifty cases (43 femoral and 7 tibial nails) were performed in 42 patients (20 males, 48% and 22 females, 52%). Six patients had bilateral lengthening and 2 patients had sequential lengthening. There were 28 antegrade femoral, 13 retrograde femoral and 5 tibia PRECICE nails, 2 tibial and 2 femoral PRECICE STRYDE nails. Mean age at surgery was 15 years old (12 to 17). Mean preoperative length discrepancy was 49 mm (20 to 90). Mean achieved lengthening was 46.5 mm (20 to 80). Mean percentage lengthening was 12.6% (5% to 25%). Nail accuracy was 96% and reliability 90%. Average distraction rate was 0.92 mm/d for femur and 0.64 mm/d for tibias. Consolidation index was 28 d/cm (18 to 43) and 39 d/cm (20 to 47), respectively. Time from completion of lengthening to independent full weight-bearing as observed in clinic was 45 days (21 to 70) and 34.2 days (23 to 50), respectively. ASAMI bone and functional scores were favorable and PROMS demonstrated high patient satisfaction levels. No significant complications were observed. CONCLUSIONS: We have demonstrated excellent clinical results and high patient satisfaction with intramedullary lengthening in a pediatric/adolescent population. We highly recommend thorough preoperative preparation, patient education, and a multidisciplinary approach. LEVEL OF EVIDENCE: Level IV.


Assuntos
Alongamento Ósseo/instrumentação , Pinos Ortopédicos/estatística & dados numéricos , Desigualdade de Membros Inferiores/cirurgia , Adolescente , Alongamento Ósseo/estatística & dados numéricos , Pinos Ortopédicos/efeitos adversos , Feminino , Fêmur/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento , Suporte de Carga
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