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1.
Bone Joint J ; 103-B(6): 1168-1172, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058877

RESUMO

AIMS: The STRYDE nail is an evolution of the PRECICE Intramedullary Limb Lengthening System, with unique features regarding its composition. It is designed for load bearing throughout treatment in order to improve patient experience and outcomes and allow for simultaneous bilateral lower limb lengthening. The literature published to date is limited regarding outcomes and potential problems. We report on our early experience and raise awareness for the potential of adverse effects from this device. METHODS: This is a retrospective review of prospective data collected on all patients treated in our institution using this implant. We report the demographics, nail accuracy, reliability, consolidation index, and cases where concerning clinical and radiological findings were encountered. There were 14 STRYDE nails implanted in nine patients (three male and six female) between June 2019 and September 2020. Mean age at surgery was 33 years (14 to 65). Five patients underwent bilateral lengthening (two femoral and three tibial) and four patients unilateral femoral lengthening for multiple aetiologies. RESULTS: At the time of reporting, eight patients (13 implants) had completed lengthening. Osteolysis and periosteal reaction at the junction of the telescopic nail was evident in nine implants. Five patients experienced localized pain and swelling. Macroscopic appearances following retrieval were consistent with corrosion at the telescopic junction. Tissue histology was consistent with effects of focal metallic wear debris. CONCLUSION: From our early experience with this implant we have found the process of lengthening to be accurate and reliable with good regenerate formation and consolidation. Proposed advantages of early load bearing and the ability for bilateral lengthening are promising. We have, however, encountered concerning clinical and radiological findings in several patients. We have elected to discontinue its use to allow further investigation into the retrieved implants and patient outcomes from users internationally. Cite this article: Bone Joint J 2021;103-B(6):1168-1172.


Assuntos
Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Desigualdade de Membros Inferiores/cirurgia , Adolescente , Adulto , Idoso , Remoção de Dispositivo , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
Medicina (Kaunas) ; 57(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071346

RESUMO

Brodie's abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie's abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie's abscess did not evolve into a 'malignant' septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.


Assuntos
Abscesso , Osteomielite , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Adulto , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Radiografia , Adulto Jovem
3.
Nat Commun ; 12(1): 3319, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083547

RESUMO

Long noncoding RNAs are widely implicated in diverse disease processes. Nonetheless, their regulatory roles in bone resorption are undefined. Here, we identify lncRNA Nron as a critical suppressor of bone resorption. We demonstrate that osteoclastic Nron knockout mice exhibit an osteopenia phenotype with elevated bone resorption activity. Conversely, osteoclastic Nron transgenic mice exhibit lower bone resorption and higher bone mass. Furthermore, the pharmacological overexpression of Nron inhibits bone resorption, while caused apparent side effects in mice. To minimize the side effects, we further identify a functional motif of Nron. The delivery of Nron functional motif to osteoclasts effectively reverses bone loss without obvious side effects. Mechanistically, the functional motif of Nron interacts with E3 ubiquitin ligase CUL4B to regulate ERα stability. These results indicate that Nron is a key bone resorption suppressor, and the lncRNA functional motif could potentially be utilized to treat diseases with less risk of side effects.


Assuntos
Osteoporose/genética , Osteoporose/metabolismo , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Animais , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/genética , Doenças Ósseas Metabólicas/metabolismo , Reabsorção Óssea/genética , Reabsorção Óssea/metabolismo , Reabsorção Óssea/prevenção & controle , Proteínas Culina/metabolismo , Receptor alfa de Estrogênio/genética , Receptor alfa de Estrogênio/metabolismo , Feminino , Fêmur/diagnóstico por imagem , Fêmur/metabolismo , Fêmur/patologia , Injeções Intravenosas , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Osteoclastos/metabolismo , Osteoclastos/patologia , Osteoporose/terapia , RNA Longo não Codificante/administração & dosagem , Ubiquitinação , Regulação para Cima , Microtomografia por Raio-X
4.
BMC Musculoskelet Disord ; 22(1): 427, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962613

RESUMO

BACKGROUND: Tributyltin, a well-known endocrine disruptor, is widely used in agriculture and industry. Previous studies have shown that tributyltin could cause deleterious effects on bone health by impairing the adipo-osteogenic balance in bone marrow. METHODS: To investigate further the effects of tributyltin on bone, weaned male SD rats were treated with tributyltin (0.5, 5 or 50 µg·kg- 1) or corn oil by gavage once every 3 days for 60 days in this study. Then, we analyzed the effects of tributyltin on geometry, the polar moment of inertia, mineral content, relative abundances of mRNA from representative genes related to adipogenesis and osteogenesis, serum calcium ion and inorganic phosphate levels. RESULTS: Micro-computed tomography analysis revealed that treatment with 50 µg·kg- 1 tributyltin caused an obvious decrease in femoral cortical cross sectional area, marrow area, periosteal circumference and derived polar moment of inertia in rats. However, other test results showed that exposure to tributyltin resulted in no significant changes in the expression of genes detected, femoral cancellous architecture, ash content, as well as serum calcium ion and inorganic phosphate levels. CONCLUSIONS: Exposure to a low dose of tributyltin from the prepubertal to adult stage produced adverse effects on skeletal architecture and strength.


Assuntos
Densidade Óssea , Fêmur , Animais , Fêmur/diagnóstico por imagem , Masculino , Ratos , Ratos Sprague-Dawley , Compostos de Trialquitina , Microtomografia por Raio-X
5.
BMC Musculoskelet Disord ; 22(1): 486, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044787

RESUMO

BACKGROUND: Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. METHODS: Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. RESULTS: PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P <  0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. CONCLUSIONS: Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.


Assuntos
Artroplastia do Joelho , Imageamento Tridimensional , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
6.
BMC Musculoskelet Disord ; 22(1): 493, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049511

RESUMO

BACKGROUND: Re-injury rates following reconstruction of the anterior cruciate ligament (ACL) are significant; in more than 20% of patients a rupture of the graft occurs. One of the main reasons for graft failure is malposition of the femoral tunnel. The femoral origin of the torn ACL can be hard to visualize during arthroscopy, plus many individual variation in femoral origin anatomy exists, which may lead to this malpositioning. To develop a patient specific guide that may resolve this problem, a preoperative MRI is needed to identify the patient specific femoral origin of the ACL. The issue here is that there may be a difference in the reliability of identification of the femoral footprint of the ACL on MRI between different observers with different backgrounds and level of experience. The purpose of this study was to determine the intra- and interobserver reliability of identifying the femoral footprint of the torn ACL on MRI and to compare this between orthopedic surgeons, residents in orthopedic surgery and MSK radiologists. METHODS: MR images of the knee joint were collected retrospectively from 20 subjects with a confirmed rupture of the ACL. The 2D (coronal, sagittal, transversal) proton-density (PD) images were selected for the segmentation procedure to create 3D models of the femurs. The center of the femoral footprint of the ACL on 20 MRI scans, with visual feedback on 3D models (as reference) was determined twice by eight observers. The intra- and interobserver reliability of determining the center of the femoral footprint on MRI was evaluated. Intraclass correlation coefficients (ICCs) were calculated for the X, Y and Z coordinates separately and for a 3D coordinate. RESULTS: The mean 3D distance between the first and second assessment (intraobserver reliability) was 3.82 mm. The mean 3D distance between observers (interobserver reliability) was 8.67 mm. ICCs were excellent (> 0.95), except for those between the assessments of the two MSK radiologists of the Y and Z coordinates (0.890 and 0.800 respectively). Orthopedic surgeons outscored the residents and radiologists in terms of intra- and interobserver agreement. CONCLUSION: Excellent intraobserver reliability was demonstrated (< 4 mm). However the results of the interobserver reliability manifested remarkably less agreement between observers (> 8 mm). An orthopedic background seems to increase both intra- and interobserver reliability. Preoperative planning of the femoral tunnel position in ACL reconstruction remains a surgical decision. Experienced orthopedic surgeons should be consulted when planning for patient specific instrumentation in ACL reconstruction.


Assuntos
Ligamento Cruzado Anterior , Tíbia , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
Orthop Clin North Am ; 52(3): 215-229, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053567

RESUMO

Rotational malreduction is a common yet underreported postoperative complication following intramedullary nailing of long bone fractures. In most situations, this can be prevented at the time of initial surgery with meticulous preoperative planning, careful use of intraoperative fluoroscopy, and awareness of risk factors for malrotation. However, rotational alignment remains difficult to assess by clinical examination so a high index of suspicion is always necessary. Here, the authors review the literature on this complication and report on 3 such cases of femoral and the tibial malrotation, methods for calculating femoral version and tibial torsion, and techniques for correcting these deformities.


Assuntos
Mau Alinhamento Ósseo , Fixação Intramedular de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Adolescente , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Fêmur/cirurgia , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Rotação , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Tíbia/cirurgia
8.
BMC Musculoskelet Disord ; 22(1): 437, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985470

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. CASE PRESENTATION: A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. CONCLUSIONS: Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior , Genu Varum , Osteoartrite do Joelho , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
9.
Anticancer Res ; 41(5): 2473-2476, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952473

RESUMO

BACKGROUND/AIM: During surgery for patients with known, diffuse metastatic bone disease (MBD), lesional tissue is routinely sent for pathological evaluation. However, there are limited data to assess whether there is a role for histopathology for MBD despite time and cost of interpretation, as well as whether a positive sample changes the subsequent treatment course. PATIENTS AND METHODS: Sixty-six cases from 2017 to 2020 were reviewed retrospectively. The median age at surgery was 63.5 years (range of 23 to 84 years), and the primary tumor was most frequently breast (24.2%, n=16), renal (21.2%, n=14) or lung (15.2%, n=10). The most common location of MBD was the femur (60.6%, n=40). RESULTS: The overall yield of a positive tissue sample of MBD was 77.3% (n=51). The positive rate from sending intramedullary reamings was 65.4% (n=17 of 26). Among the 66 cases (63 patients), a change in the subsequent clinical management was recorded in 9.1% (n=6). The most common change was related to the medication regimen (n=5), with one change related to recognition of the carcinoma origin via histology, which was previously unknown. CONCLUSION: Despite the routine practice of sending tissue for histology during surgery for known and diffuse MBD, a change in the subsequent clinical management is uncommon. Prior to sending tissue, surgeons should discuss this practice with the multidisciplinary care team on a per-patient basis.


Assuntos
Doenças Ósseas/cirurgia , Neoplasias da Mama/cirurgia , Fêmur/cirurgia , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Resultado do Tratamento
10.
Int J Mol Sci ; 22(9)2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33946764

RESUMO

Micro arc oxidation (MAO) is a prominent surface treatment to form bioceramic coating layers with beneficial physical, chemical, and biological properties on the metal substrates for biomaterial applications. In this study, MAO treatment has been performed to modify the surface characteristics of AZ31 Mg alloy to enhance the biocompatibility and corrosion resistance for implant applications by using an electrolytic mixture of Ca3(PO4)2 and C10H16N2O8 (EDTA) in the solutions. For this purpose, the calcium phosphate (Ca-P) containing thin film was successfully fabricated on the surface of the implant material. After in-vivo implantation into the rabbit bone for four weeks, the apparent growth of soft tissues and bone healing effects have been documented. The morphology, microstructure, chemical composition, and phase structures of the coating were identified by SEM, XPS, and XRD. The corrosion resistance of the coating was analyzed by polarization and salt spray test. The coatings consist of Ca-P compounds continuously have proliferation activity and show better corrosion resistance and lower roughness in comparison to mere MAO coated AZ31. The corrosion current density decreased to approximately 2.81 × 10-7 A/cm2 and roughness was reduced to 0.622 µm. Thus, based on the results, it was anticipated that the development of degradable materials and implants would be feasible using this method. This study aims to fabricate MAO coatings for orthopedic magnesium implants that can enhance bioactivity, biocompatibility, and prevent additional surgery and implant-related infections to be used in clinical applications.


Assuntos
Regeneração Óssea , Substitutos Ósseos/química , Fosfatos de Cálcio/química , Materiais Revestidos Biocompatíveis/química , Ligas/química , Animais , Parafusos Ósseos , Linhagem Celular , Cerâmica , Corrosão , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Teste de Materiais , Camundongos , Microscopia Eletrônica de Varredura , Modelos Animais , Oxirredução , Espectroscopia Fotoeletrônica , Próteses e Implantes , Coelhos , Propriedades de Superfície , Difração de Raios X , Microtomografia por Raio-X
11.
Yonsei Med J ; 62(5): 439-445, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33908215

RESUMO

PURPOSE: We aimed to investigate the accuracy of two-dimensional computed tomography (2D-CT)-based methods for measuring rotational alignment of the femoral component during total knee arthroplasty in comparison to reference values for three-dimensional (3D) reconstruction. MATERIALS AND METHODS: We selected the "most protruding transepicondylar axis section," "most protruding posterior condylar line section," and "distal femoral cut section" on 2D-CT images for 100 knees. We investigated posterior condylar angle (PCA) and condylar twist angle (CTA) values using three different methods on 2D-CT and compared to these values to those obtained using a 3D model. RESULTS: The mean PCA and CTA values were 2.8° and 7.0° on the 3D model and 2.0° to 2.1° and 5.9° to 6.0° on 2D-CT, respectively. Errors in PCA and CTA measurement included internal rotation of 0.8° and 1.1° with the 1-plane and 2-plane methods and 0.9° and 1.0° with the assumed resection method, respectively. CONCLUSION: Mean errors in PCA and CTA values measured using three different methods on 2D-CT were not significantly different. However, PCA and CTA values measured on 2D-CT were approximately 1° smaller than their 3D values. Thus, we suggest that adding 1° to the mean PCA and CTA values obtained from a single plane of 2D-CT would provide values similar to those obtained from 3D reconstruction.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Valores de Referência , Rotação , Tomografia Computadorizada por Raios X
12.
Nat Commun ; 12(1): 2136, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33837198

RESUMO

Osteoclastic bone resorption and osteoblastic bone formation/replenishment are closely coupled in bone metabolism. Anabolic parathyroid hormone (PTH), which is commonly used for treating osteoporosis, shifts the balance from osteoclastic to osteoblastic, although it is unclear how these cells are coordinately regulated by PTH. Here, we identify a serine protease inhibitor, secretory leukocyte protease inhibitor (SLPI), as a critical mediator that is involved in the PTH-mediated shift to the osteoblastic phase. Slpi is highly upregulated in osteoblasts by PTH, while genetic ablation of Slpi severely impairs PTH-induced bone formation. Slpi induction in osteoblasts enhances its differentiation, and increases osteoblast-osteoclast contact, thereby suppressing osteoclastic function. Intravital bone imaging reveals that the PTH-mediated association between osteoblasts and osteoclasts is disrupted in the absence of SLPI. Collectively, these results demonstrate that SLPI regulates the communication between osteoblasts and osteoclasts to promote PTH-induced bone anabolism.


Assuntos
Reabsorção Óssea/tratamento farmacológico , Osteogênese/fisiologia , Hormônio Paratireóideo/administração & dosagem , Inibidor Secretado de Peptidases Leucocitárias/metabolismo , Animais , Reabsorção Óssea/patologia , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/fisiologia , Linhagem Celular , Modelos Animais de Doenças , Feminino , Fêmur/citologia , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Fêmur/patologia , Humanos , Masculino , Camundongos , Camundongos Knockout , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Osteoclastos/efeitos dos fármacos , Osteoclastos/metabolismo , Osteogênese/efeitos dos fármacos , Cultura Primária de Células , RNA-Seq , Inibidor Secretado de Peptidases Leucocitárias/genética , Regulação para Cima/efeitos dos fármacos , Microtomografia por Raio-X
13.
Arthroscopy ; 37(4): 1212-1213, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812524

RESUMO

Trochlear dysplasia is one of the primary morphologic abnormalities associated with patellar instability. Although qualitative classifications based on trochlear shape such as the Dejour classification exist, radiographic measurements to quantify the severity of trochlear dysplasia are numerous and varied. Each measurement addresses a different element of the complex and wide-ranging presentations that exist along a spectrum of abnormalities in trochlear morphology, and the reported reliability of such measurements are mixed. Overall, our understanding of trochlear dysplasia continues to evolve, and the ability to quantify the morphology of the trochlea, as well as its influence on patellar stability, remains a work in progress. Future directions include developing improved 3-dimensional descriptions of trochlear anatomy, as well as standardizing measurement methods and image slice selection, to better evaluate trochlear morphology in the assessment of patellar instability.


Assuntos
Instabilidade Articular , Articulação do Joelho , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Reprodutibilidade dos Testes
14.
BMC Musculoskelet Disord ; 22(1): 321, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33794854

RESUMO

BACKGROUND: Patient-specific instrumentation (PSI) proponents have suggested the benefits of improved component alignment and reduced outliers. In this randomized controlled trial, we attempted to assess the advantage of using PSI over conventional intermedullary (IM) guides for primary total knee arthroplasty (TKA) with bilateral severe femoral bowing (> 5°). A parallel trial design was used with 1:1 allocation. We hypothesize that PSI would support more accurate alignment of components and the lower-limb axis during TKA with severe femoral bowing in comparison with conventional IM guides. METHODS: Among 336 patients undergoing bilateral TKAs due to knee osteoarthritis, 29 patients with bilateral lateral femoral bowing of more than 5° were included in this study. Every patient was assigned randomly to PSI on one side and to conventional instrumentation lateralization of the entry point of the femoral IM guide was applied on the other with a goal of neutral mechanical alignment. The assessment of coronal alignment was completed by measuring the hip-knee-ankle (HKA) angle on preoperative and postoperative long film standing radiographs. Coronal and sagittal orientations of femoral and tibial components were assessed on weight-bearing radiographs. The rotational alignment of the femoral component was evaluated using computed tomography. RESULTS: The postoperative mean ± standard deviation (SD) HKA angle was varus 4.0° (± 2.7°) for conventional technique and varus 4.1° (± 3.1°) for PSI, with no differences between the two groups (p = 0.459). The component orientation showed no significant differences except with respect to the sagittal alignment of the femoral component (p = 0.001), with a PSI mean ± SD flexion of 5.8° (± 3.7°) and a conventional method mean ± SD flexion of 3.2° (± 2.5°), due to the intentional 3° flexion incorporated in the sagittal plane to prevent femoral notching in PSI planning. Computed tomography assessment for rotational alignment of the femoral components showed no difference between the two groups concerning the transepicondylar axis (p = 0.485) with a PSI mean ± SD external rotation of 1.5° (± 1.3°) and conventional mean ± SD external rotation of 1.5° (± 1.6°). CONCLUSION: PSI showed no advantage over lateralization of the femoral entry for IM guidance. LEVEL OF EVIDENCE: 1 TRIAL REGISTRATION: Registered on US national library of medicine ClinicalTrials.gov ( NCT02993016 ) on December 12th 2016.


Assuntos
Artroplastia do Joelho , Genu Varum , Prótese do Joelho , Osteoartrite do Joelho , Cirurgia Assistida por Computador , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos
15.
Biomed Res Int ; 2021: 8813300, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33791382

RESUMO

Objective: The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods: Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results: The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02% to a postoperative value of 56.19 ± 0.10% from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08% at the final follow-up (P < 0.01). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values (P > 0.05). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63° to a postoperative week-one valgus of 2.37 ± 0.28°, and it had a valgus of 2.48 ± 0.39° at the final follow-up (P < 0.01). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26° (P > 0.05). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53° and 90.33 ± 1.52°, respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72° and the intraoperative setting value of 90.25 ± 1.67° (P > 0.05). All corrected values were within the acceptable range of preoperative planning. Conclusion: Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.


Assuntos
Fêmur , Fíbula , Articulação do Joelho , Osteoartrite do Joelho , Osteotomia , Cuidados Pré-Operatórios , Adulto , Feminino , Fêmur/diagnóstico por imagem , Fêmur/fisiopatologia , Fêmur/cirurgia , Fíbula/diagnóstico por imagem , Fíbula/fisiopatologia , Fíbula/cirurgia , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Período Pós-Operatório , Estudos Retrospectivos
16.
Int J Mol Sci ; 22(6)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33802646

RESUMO

The aim of this study was to determine the effects of ß-hydroxy-ß-methylbutyrate (HMB) supplementation during pregnancy on postpartum bone tissue quality by assessing changes in trabecular and compact bone as well as in hyaline and epiphyseal cartilage. The experiment was carried out on adult 6-month-old female spiny mice (Acomys cahirinus) divided into three groups: pregnant control (PregCont), pregnant HMB-treated (supplemented with 0.02 g/kg b.w of HMB during the second trimester of pregnancy, PregHMB), and non-pregnant females (NonPreg). Cross-sectional area and cortical index of the femoral mid-shaft, stiffness, and Young modulus were significantly greater in the PregHMB group. Whole-bone mineral density was similar in all groups, and HMB supplementation increased trabecular number. Growth plate cartilage was the thinnest, while the articular cartilage was the thickest in the PregHMB group. HMB supplementation increased the content of proteoglycans in the articular cartilage and the percentage of immature collagen content in metaphyseal trabeculae and compact bone. In summary, dietary HMB supplementation during the second trimester of pregnancy intensifies bone metabolic processes and prevents bone loss during pregnancy.


Assuntos
Reabsorção Óssea/tratamento farmacológico , Reabsorção Óssea/prevenção & controle , Valeratos/uso terapêutico , Animais , Peso Corporal/efeitos dos fármacos , Reabsorção Óssea/diagnóstico por imagem , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/efeitos dos fármacos , Osso Esponjoso/patologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/patologia , Colágeno/metabolismo , Epífises/efeitos dos fármacos , Epífises/patologia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Fêmur/patologia , Murinae , Gravidez , Proteoglicanas/metabolismo , Valeratos/farmacologia , Microtomografia por Raio-X
17.
Comput Methods Programs Biomed ; 204: 106072, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33819822

RESUMO

BACKGROUND AND OBJECTIVE: The aim of the present study was to review the literature concerning the analysis of periprosthetic bone remodeling through finite element (FE) simulation. METHODS: A systematic review was conducted on 9 databases, taking into account a ten-year time period (from 2009 until 2020). The inclusion criteria were: articles published in English, publication date after 2009, full text articles, articles containing the keywords both in the abstract and in the title. The articles were classified through the following parameters: dimensionality of the simulation, modelling of the bone-prosthesis interface, output parameters, type of simulated prosthesis, bone remodeling algorithm. RESULTS: Sixty-seven articles were included in the study. Femur and tooth were the most evaluated bone segment (respectively 41.8% and 29.9%). The 55.2% of the evaluated articles used a bonded bone-prosthesis interface, 73% used 3D simulations, 67.2% of the articles (45 articles) evaluate the bone remodeling by the bone density variation. At last, 59.7% of the articles employed algorithms based on a specific remodeling function. CONCLUSIONS: Increasing interest in the bone remodeling FE analysis in different bone segments emerged from the review, and heterogeneous solutions were adopted. An optimal balance between computational cost and accuracy is needed to accurately simulate the bone remodeling phenomenon in the post-operative period.


Assuntos
Remodelação Óssea , Fêmur , Densidade Óssea , Simulação por Computador , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Análise de Elementos Finitos , Modelos Biológicos
18.
J Int Med Res ; 49(4): 3000605211001643, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33845598

RESUMO

An atypical femoral fracture (AFF) is a rare complication associated with excessive inhibition of osteoclast expression during treatment of osteoporosis. We herein describe a patient who had been treated with alendronate for more than 10 years and subsequently developed an AFF that healed after treatment with vitamin K2 (VK2). We also discuss the potential beneficial effects of VK2 on the healing of AFFs. A 48-year-old Asian man with secondary osteoporosis was treated with alendronate for more than 10 years. The patient underwent surgical treatment for a complete AFF of the right femur. Six months postoperatively, he complained of pain in his left thigh. X-ray examination revealed an incomplete AFF of the left femoral shaft. He was then treated with VK2. After 4 months of VK2 treatment, the patient reported that the pain in his left thigh had decreased, and follow-up X-ray examination demonstrated healing of the left AFF line. This case report indicates that VK2 may be a potential direction for pharmacological treatment of AFFs in future research.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Osteoporose , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/tratamento farmacológico , Fraturas do Fêmur/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Vitamina K 2/uso terapêutico
19.
BMC Musculoskelet Disord ; 22(1): 363, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865360

RESUMO

BACKGROUND: The evaluation of postoperative total knee arthroplasty (TKA) alignment mainly relies on measurement data obtained from plain radiographs. The aim of this retrospective observational study was to document the intra- and inter-observer reliability in assessment of TKA component positioning after surgery using a three-dimensional (3D) computed tomography (CT) image matching system. METHODS: Fourteen knees from 14 patients who received primary TKA were included, and images were analyzed by blinded readers not associated with the surgeries. The examiner digitized the reference points according to defined landmarks, and the designated size component was superimposed to the 3D reconstructed CT model for measurement. In addition to the evaluation of implant position against the coronal and sagittal lower limb mechanical axes that were defined based on bony landmarks, implant position against axes connecting implant-based reference points that are easier to indicate was evaluated. RESULTS: The overall intra- and inter-observer reliabilities determined by the intraclass correlation coefficients (ICC) of the implant alignment measurement for both femoral and tibial components were good (ICC > 0.60), except in the direction of femoral flexion and extension, for both mechanical and implant-based axes. The difference between implant alignment measurements according to the traditional mechanical axis and the implant-based axis ranged between means of 0.08o and 1.70o and were statistically significantly different. CONCLUSIONS: The postoperative evaluation of implant position in the coronal and sagittal planes using 3D-CT image matching is reliable and has good reproducibility except for the sagittal alignment assessment of the femoral component. The measured implant position according to the traditional mechanical axis and the implant-based axis were slightly but significantly different.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Reprodutibilidade dos Testes , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios X
20.
BMC Musculoskelet Disord ; 22(1): 371, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879133

RESUMO

BACKGROUND: With regard to biomechanical testing of orthopaedic implants, there is no consensus on whether artificial creation of standardized bone fractures or their simulation by means of osteotomies result in more realistic outcomes. Therefore, the aim of this study was to artificially create and analyze in an appropriate setting the biomechanical behavior of standardized stable pertrochanteric fractures versus their simulation via osteotomizing. METHODS: Eight pairs of fresh-frozen human cadaveric femora aged 72.7 ± 14.9 years (range 48-89 years) were assigned in paired fashion to two study groups. In Group 1, stable pertrochanteric fractures AO/OTA 31-A1 were artificially created via constant force application on the anterior cortex of the femur through a blunt guillotine blade. The same fracture type was simulated in Group 2 by means of osteotomies. All femora were implanted with a dynamic hip screw and biomechanically tested in 20° adduction under progressively increasing physiologic cyclic axial loading at 2 Hz, starting at 500 N and increasing at a rate of 0.1 N/cycle. Femoral head fragment movements with respect to the shaft were monitored by means of optical motion tracking. RESULTS: Cycles/failure load at 15° varus deformation, 10 mm leg shortening and 15° femoral head rotation around neck axis were 11324 ± 848/1632.4 ± 584.8 N, 11052 ± 1573/1605.2 ± 657.3 N and 11849 ± 1120/1684.9 ± 612.0 N in Group 1, and 10971 ± 2019/1597.1 ± 701.9 N, 10681 ± 1868/1568.1 ± 686.8 N and 10017 ± 4081/1501.7 ± 908.1 N in Group 2, respectively, with no significant differences between the two groups, p ≥ 0.233. CONCLUSION: From a biomechanical perspective, by resulting in more consistent outcomes under dynamic loading, standardized artificial stable pertrochanteric femur fracture creation may be more suitable for orthopaedic implant testing compared to osteotomizing the bone.


Assuntos
Ortopedia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Pessoa de Meia-Idade , Osteotomia
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