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1.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

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


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
2.
Bone Joint J ; 101-B(8): 897-901, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362553

RESUMO

Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in hip arthroplasty. However, ceramic fracture remains a concern. We have reviewed the contemporary literature, addressing the factors that can influence the incidence of ceramic bearing surface fracture. Cite this article: Bone Joint J 2019;101-B:897-901.


Assuntos
Artroplastia de Quadril/instrumentação , Cerâmica , Prótese de Quadril , Desenho de Prótese , Falha de Prótese , Cerâmica/efeitos adversos , Prótese de Quadril/efeitos adversos , Humanos , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia
4.
Braz J Cardiovasc Surg ; 34(3): 318-326, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310471

RESUMO

OBJECTIVES: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). METHODS: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. RESULTS: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). CONCLUSION: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Humanos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
5.
Braz J Cardiovasc Surg ; 34(3): 361-365, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310476

RESUMO

Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/mortalidade , Falha de Tratamento
6.
BMJ ; 366: l4230, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266745

RESUMO

The studyFawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data. Value Health 2019;22:303-12.This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people.


Assuntos
Artroplastia de Quadril , Desenho de Equipamento , Prótese de Quadril , Complicações Pós-Operatórias , Reoperação , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cerâmica/uso terapêutico , Análise Custo-Benefício , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Feminino , Prótese de Quadril/classificação , Prótese de Quadril/normas , Humanos , Masculino , Próteses Articulares Metal-Metal , Osteoartrite do Quadril/cirurgia , Avaliação de Resultados (Cuidados de Saúde) , Polietileno/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Reino Unido
7.
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
8.
Bone Joint J ; 101-B(5): 610-614, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039055

RESUMO

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


Assuntos
Artroplastia do Ombro/métodos , Úmero/cirurgia , Falha de Prótese/efeitos adversos , Prótese de Ombro/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/efeitos adversos , Feminino , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
9.
Biomed Res Int ; 2019: 7814602, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061827

RESUMO

Austin-Moore hemiarthroplasty (HA) had been selectively used for elderly patients with femoral neck fractures. With increasing life span and activity, the sequela of Austin-Moore HA make the implant no longer favorable. The treatment of failed Austin-Moore HA with advanced acetabular erosion is challenging; however, little has been published regarding this topic. The aim of this study was to evaluate the mid-term results of using cementless total hip arthroplasty (THA) in octogenarians. Between 2008 and 2011, 47 patients (32 women and 15 men) with an average age of 86 years (range 83-89 years) were enrolled in this retrospective study. After an average follow-up period of 6.2 years (range 5.0-7.8 years), no migration or loosening of the cup or femoral stem was found. Harris hip scores improved from 36 (range 15-42) preoperatively to 87 (range 80-90). There were no complications directly associated with the procedure except for superficial infections in two patients. Our results suggest that using cementless THA can result in favorable radiographic and clinical outcomes in octogenarian patients.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril , Fraturas do Colo Femoral , Hemiartroplastia , Prótese de Quadril , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Seguimentos , Humanos , Masculino , Falha de Prótese/efeitos adversos , Reoperação , Estudos Retrospectivos
10.
J Shoulder Elbow Surg ; 28(6S): S175-S180, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31014559

RESUMO

BACKGROUND: The early results of reverse shoulder arthroplasty (RSA) were influenced to some extent by the use of first-generation implants and surgeons' learning curves, resulting in relatively high reoperation rates. The purpose of this study was to quantify the burden of and identify the indications for reoperation after primary RSA using contemporary implants and techniques. METHODS: A retrospective review of 1649 primary RSAs implanted consecutively between 2009 and 2015 at a single institution was conducted. All arthroplasties were performed by 5 fellowship-trained shoulder surgeons at a tertiary referral center. Demographic characteristics, indications for primary RSA, and reoperations were analyzed and categorized for trends associated with each type of reoperation performed. RESULTS: A total of 39 reoperations (2.37%) were performed for a variety of indications. Overall, only a few patients with infection or instability required reoperation (0.55%). The most common indications for reoperation were related to the humeral component (1.03%); the majority of humeral component complications were related to a specific design flaw of 1 implant system. RSAs performed for proximal humeral fracture sequelae more commonly underwent reoperation owing to instability or humeral component-related issues; all 4 cases of aseptic humeral stem loosening occurred in the setting of proximal humeral fracture sequela treatment. Only 0.36% of all primary RSAs required reoperation because of glenoid complications. CONCLUSIONS: Primary RSA performed with contemporary implants and surgical techniques seems to be associated with a very low rate of reoperation. The most common reasons for reoperation were humeral component fracture for 1 particular implant, humeral loosening, dislocation, infection, and glenoid failure, each occurring at a rate under 1%.


Assuntos
Artroplastia do Ombro/instrumentação , Falha de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Prótese de Ombro , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto Jovem
11.
Biomed Mater Eng ; 30(3): 297-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31006657

RESUMO

BACKGROUND: Breakage of joint arthroplasty components are rare, yet during an implant retrieval program we found several cases. OBJECTIVE: In this study we examined the components to determine the causes and mechanisms of breakage of these implants. METHODS: From our collection of 849 retrievals we selected 682 cases with metal parts (503 hip, 79 knee arthroplasties) and identified fractured components: seven hip resurfacing implants, five total hip replacement stems, one monopolar femoral head, and one modular revision femoral stem from. Implants were examined using optical and scanning electron microscopy; metallographic sections were prepared and samples of periprosthetic tissues underwent microscopic examination. RESULTS: In the resurfacing components breakage occurred in small stems placed in the femoral neck due to necrosis of femoral heads, with no metal flaws detected. Fatigue breakage of femoral stems was caused by presence of material flaws in the CoCrMo alloy, and corrosion. The monopolar head failed in fatigue fracture mechanism, breakage was initiated in an undercut near the taper connection for femoral component. The modular stem from Ti alloy sustained fatigue fracture induced by corrosion caused by debris from previously revised stem; no material flaws were detected in this sample. In most cases periprosthetic tissues had a morphology typical for aseptic loosening. CONCLUSIONS: In our series failure was caused by material flaws, presence of stress raisers and localized corrosion. Our findings indicate that sharp edges and other features which can act as stress raisers should be avoided in newly designed implants. Corrosion induced fracture of the modular Ti stem indicates the need for a detailed debridement of periprosthetic tissues during revision arthroplasties.


Assuntos
Prótese de Quadril , Falha de Prótese , Vitálio , Artroplastia de Quadril/efeitos adversos , Corrosão , Análise de Falha de Equipamento , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Desenho de Prótese , Falha de Prótese/efeitos adversos , Vitálio/efeitos adversos , Vitálio/química
12.
J Cardiothorac Surg ; 14(1): 62, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885227

RESUMO

BACKGROUND: This study investigated the extent and nature of cardiac morbidity and cause of mortality in patients with Mitroflow structural valve deterioration (SVD). METHODS: A retrospective study was performed examining the medical records of patients who had received Mitroflow bioprosthesis between February 2001 and April 2014 and died during this period. A total of 211 patients were identified and included in the analyses. To determine the cause of mortality, cases were divided into three predefined groups: cardiovascular death due to SVD (group 1), cardiovascular death with no SVD (group 2) and non-cardiovascular death without SVD (group 3). RESULTS: Overall mortality in this study was 7.6% at 1 year, 46.4% at 5 years and 97.2% at 10 years. In group 1, 53 patients (25%) died; in group 2, 59 patients (28%) died; and in group 3, 99 patients (47%) died. Hospitalisation for congestive heart failure was observed in 49.1% in the SVD group vs. 10.2 and 13.1% in the two other groups, p < 0.001. Hospitalisation for endocarditis was also significantly higher in the SVD group (11.3%) than in the two other groups (6.8 and 0%), p < 0.05. Hospitalisation due to myocardial infarction, cerebral stroke, arrhythmia or other cardiac-related diseases was not significantly different between groups. CONCLUSION: Structural valve deterioration in Mitroflow bioprosthesis was associated with a high prevalence of hospital admissions due to congestive heart failure and endocarditis. Patients with Mitroflow bioprosthesis should be systematically and routinely followed with echocardiography, and reoperation should be considered if SVD has developed.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite/etiologia , Endocardite/mortalidade , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Reoperação , Estudos Retrospectivos , Análise de Sobrevida
14.
J Comput Assist Tomogr ; 43(3): 379-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30855312

RESUMO

PURPOSE: The aim of the study was to assess potential endoprosthesis loosening in patients after revision total hip arthroplasty, based on monochromatic dual-energy computed tomography (DECT) images obtained with and without metal artifact reduction software (MARS) and comparison with the clinical examination and hip function. MATERIALS AND METHODS: Twenty-five consecutive patients underwent DECT examinations. Two monochromatic data sets were generated: with MARS (75-keV MARS) and without MARS (140-keV non-MARS) and evaluated for signs of loosening, using a dedicated radiological score. The Harris Hip Score (HHS) was used to evaluate patients' hip function. RESULTS: The mean radiological score for loosening in the non-MARS group was 16.2, in the MARS group 17.0 and was significantly higher (P < 0.001). Radiological loosening evaluation in non-MARS images correlated with the HHS score (ρ = 0.43, P = 0.03), whereas there was no correlation between MARS images and HHS (ρ = 0.15, P = 0.47). New MARS-related artifacts, which hinder implant-bone interface evaluation, were found in 75-keV MARS images ("pseudo-loosening" in 33 of 34 prostheses, "ground-glass blurring" in 20 of 32). CONCLUSIONS: High-energy monochromatic DECT images are superior to low-energy DECT MARS images in assessment of the potential loosening and correlate better with the clinical examination outcomes. For revision total hip arthroplasty evaluation, 2 data sets should be assessed inseparably because of extra artifacts in MARS images.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/efeitos adversos , Quadril/diagnóstico por imagem , Falha de Prótese/efeitos adversos , Reoperação/instrumentação , Feminino , Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Sensibilidade e Especificidade , Software , Tomografia Computadorizada por Raios X/métodos
15.
BMC Musculoskelet Disord ; 20(1): 118, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894158

RESUMO

BACKGROUND: We report a case of hardware failure after distal femoral osteotomy (DFO) with a broken screw pulled out from the locking hole and positioned within the knee joint. CASE PRESENTATION: A 57-year-old man presented to our orthopedic outpatient department with 3-months history of an unusual painful swelling at the operated area following DFO. The leakage of joint fluid from the penetrated suprapatellar pouch was assumed to be the reason for this complication. CONCLUSIONS: The overall aim of this case report is to provide a lesson to budding surgeons who might experience a similar situation that cannot be easily explained, like the unexpected complication in the present case.


Assuntos
Parafusos Ósseos/efeitos adversos , Fêmur/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/efeitos adversos , Falha de Prótese/efeitos adversos , Fêmur/cirurgia , Migração de Corpo Estranho/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/instrumentação , Resultado do Tratamento
16.
BMJ Case Rep ; 12(2)2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30814101

RESUMO

Certain interventional pulmonology procedures such as the placement of a tracheal stent or resection of stenosing tracheal tumours require rigid bronchoscopy under general anaesthesia. Unlike an endotracheal tube with a cuff, the rigid bronchoscope only partially protects the airway from bronchoaspiration. For this reason, this procedure is performed on an elective basis in fasted patients. We describe the case of a 60-year-old man with acute respiratory distress requiring emergent rigid bronchoscopy following distal migration of a tracheal stent. One hour before the procedure, the patient had eaten a full meal. Gastric emptying was accelerated by perfusion of intravenous erythromycin and verified by endoscopy with a small diameter gastric endoscope under local anaesthesia. This 1 min procedure was very well tolerated by the patient and allowed to verify with certainty that the stomach was empty. The urgent rigid bronchoscopy for stent retrieval could then be performed safely without any risk of bronchoaspiration.


Assuntos
Broncoscopia/métodos , Remoção de Dispositivo/métodos , Eritromicina/administração & dosagem , Esvaziamento Gástrico/efeitos dos fármacos , Falha de Prótese/efeitos adversos , Insuficiência Respiratória/etiologia , Endoscopia , Fármacos Gastrointestinais/administração & dosagem , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/terapia , Stents , Vigília
17.
Int J Pediatr Otorhinolaryngol ; 120: 64-67, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30771555

RESUMO

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.


Assuntos
Implantes Cocleares/efeitos adversos , Imãs/efeitos adversos , Falha de Prótese/efeitos adversos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Criança , Implante Coclear/efeitos adversos , Implante Coclear/instrumentação , Feminino , Hospitalização , Humanos
18.
J Bone Joint Surg Am ; 101(3): 239-249, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30730483

RESUMO

BACKGROUND: For patients undergoing 2-stage exchange for the treatment of periprosthetic joint infection (PJI) following total knee arthroplasty, the long-term risk of reinfection and mechanical failure and long-term clinical outcomes are not well known. The purpose of our study was to determine the long-term clinical results of 2-stage exchange for PJI following total knee arthroplasty. METHODS: We identified 245 knees that had undergone total knee arthroplasty and were subsequently treated with 2-stage exchange due to infection during the period of 1991 to 2006; the cohort had no prior treatment for PJI. Major, or 4 of 6 minor, Musculoskeletal Infection Society (MSIS) diagnostic criteria were fulfilled by 179 (73%) of the knees. The cumulative incidence of reinfection and of aseptic revision, accounting for the competing risk of death, were calculated. Risk factors for reinfection were evaluated using Cox proportional hazards regression. Knee Society Score (KSS) values were calculated. The mean age at spacer insertion was 68 years; 50% of the patients were female. The mean follow-up was 14 years (range, 2 to 25 years) following reimplantation. RESULTS: The cumulative incidence of reinfection was 4% at 1 year, 14% at 5 years, 16% at 10 years, and 17% at 15 years. Factors that were predictive of reinfection included a body mass index of ≥30 kg/m (hazard ratio [HR], 3.1; p < 0.01), previous revision surgery (HR, 2.8; p < 0.01), and a McPherson host grade of C (HR, 2.5; p = 0.04). The cumulative incidence of aseptic revision for loosening was 2% at 5 years, 5% at 10 years, and 7% at 15 years. Femoral (HR, 5.0; p = 0.04) and tibial (HR, 6.7; p < 0.01) bone-grafting at reimplantation were predictive of aseptic failure. The most common complications were wound-healing issues, requiring reoperation in 12 (5%) of the knees. The rate of death at 2 years following reimplantation was 11%. The mean KSS improved from 45 at PJI diagnosis to 76 at 10 years following reimplantation (p < 0.01). CONCLUSIONS: Long-term reinfection rates following 2-stage exchange for PJI after total knee arthroplasty were similar to those of shorter-term reports and were maintained out to 15 years. Mechanical failure rates were low if bone loss was addressed at the time of reimplantation. Improvements in clinical outcomes were maintained at long-term follow-up. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle , Adulto , Idoso , Artroplastia do Joelho/métodos , Reabsorção Óssea/etiologia , Protocolos Clínicos , Quimioterapia Combinada , Feminino , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tobramicina/administração & dosagem , Resultado do Tratamento , Vancomicina/administração & dosagem , Adulto Jovem
19.
J Bone Joint Surg Am ; 101(3): 250-256, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30730484

RESUMO

BACKGROUND: Prior work suggests that computer-assisted navigation improves acetabular component position during primary total hip arthroplasty (THA). However, it is not known whether this translates to improvements in clinical outcomes. The purpose of this study was to test for associations between navigation use and the risk of dislocation, aseptic revision of the acetabular component, aseptic revision of the femoral component, aseptic revision of either component, and acute periprosthetic joint infection (PJI). METHODS: This was a retrospective cohort study, conducted using the 100% Medicare Part A claims data set. Inclusion criteria were an age of ≥65 years and primary THA for osteoarthritis. First, the association between navigation use and patient and hospital characteristics was assessed. Second, while controlling for these characteristics, multivariate regression was used to test for the association of navigation use and the outcomes listed above. RESULTS: A total of 803,732 primary THA procedures were identified; 14,540 (1.81%) involved the use of navigation. Navigation use was associated with younger age, other/unknown race, the Western census region, higher socioeconomic status, lower Charlson Comorbidity Index, shorter length of stay, private hospitals, teaching hospitals, and larger hospitals (p < 0.05 for each). Navigation use was associated with a lower rate of dislocation (1.00% versus 1.70% for no navigation; adjusted hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.58 to 0.82; p < 0.001) and aseptic revision of the acetabular component (1.03% versus 1.55%; adjusted HR = 0.75; 95% CI = 0.64 to 0.88; p < 0.001). Navigation was not associated with aseptic revision of the femoral component (1.54% versus 1.87%; p = 0.064), aseptic revision of either component (1.91% versus 2.31%; p = 0.077), acute PJI at 6 weeks (0.34% versus 0.45%; p = 0.121), or acute PJI at 90 days (0.50% versus 0.66%; p = 0.458). CONCLUSIONS: The findings of this study suggest that navigation is associated with reductions in the rates of dislocation and aseptic acetabular revision following primary THA. However, these results should be interpreted carefully in the setting of potential confounding by unmeasured variables, such as surgeon volume, family support, and patient compliance. Causality cannot be inferred until further prospective trials can vet this technology. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Cirurgia Assistida por Computador/métodos , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Feminino , Luxação do Quadril/prevenção & controle , Humanos , Tempo de Internação , Masculino , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
J Bone Joint Surg Am ; 101(3): 265-269, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30730486

RESUMO

BACKGROUND: Cementless stems demonstrate excellent long-term survival, but little is known about the long-term survival rate of the stem after isolated cup revision. The aim of the present retrospective cohort study was to determine the long-term survival rate of cementless stems retained after prior cup revision. METHODS: We reviewed the clinical and radiographic results of 119 total hip arthroplasties (THAs) utilizing a cementless, grit-blasted, tapered titanium femoral stem that were performed in 113 patients between January 1985 and December 1989. The mean age at the time of the primary THA was 52 years (range, 16 to 74 years) and the mean time between primary THA and cup revision was 13 years (standard deviation [SD], 6 years; range, 0 to 30 years). At the time of the latest follow-up, no patient was lost to follow-up, 36 patients representing 37 hips had died, and 11 hips in 11 patients had required stem revision. The mean follow-up was 13 years following cup revision (SD, 6 years; range, 0 to 28 years). A competing risk analysis was performed to estimate the survival of the stem after isolated cup revision, with death being the competing risk factor. RESULTS: At 20 years after cup revision, the survival rate of retained stems was 89% (95% confidence interval [CI], 79% to 94%) for the end point of stem revision for any reason and 97% (95% CI, 91% to 99%) for the end point of stem revision for aseptic loosening. CONCLUSIONS: The long-term survival of cementless stems retained after cup revision was excellent. Well-fixed cementless stems should be retained during cup revision for aseptic loosening. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Prótese de Quadril/estatística & dados numéricos , Adolescente , Adulto , Idoso , Artroplastia de Quadril/mortalidade , Cimentos para Ossos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/mortalidade , Fraturas Periprotéticas/cirurgia , Cuidados Pós-Operatórios , Desenho de Prótese , Falha de Prótese/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
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