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1.
Foot Ankle Spec ; 13(5): 372-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32924584

RESUMO

BACKGROUND: Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. METHODS: We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. RESULTS: FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). CONCLUSION: Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed.Level of Evidence: Level IV: Case series.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/métodos , Osteonecrose/cirurgia , Impressão Tridimensional , Tálus/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tálus/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Rev Prat ; 70(4): 409-415, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32877099

RESUMO

Hip osteonecrosis. Hip osteonecrosis of the is a relatively common pathology, responsible for pain and functional disability mainly affecting young people. It corresponds to bone necrosis of the femoral head, secondary to ischemic and/or cytotoxic mechanisms. They can be unilateral, bilateral or multifocal, thus testifying to the systemic nature of their origin and the importance of the general factors involved in their occurrence. Many risk factors are to be looked for, such as corticosteroid therapy, alcohol abuse, dyslipidemia or sickle cell anemia. MRI is the examination that allows a positive diagnosis and should be offered in the face of any unexplained pain in the young subject, with a normal X-ray. In advanced forms with a collapse of the joint surface and then secondary arthritis, surgical treatment with arthroplasty is the main possible option. The hip prosthesis provides these patients with a comfortable life; but it is not without risk taking into account the pathology which is usually the cause of osteonecrosis: in fact, osteonecrosis of the hip is often associated with serious medical pathologies such as hemoglobinopathies (sickle cell anemia in particular), taking corticosteroids in large doses in connection with organ transplantation or diseases such as lupus erythematosus, autoimmune diseases, hyperlipidemias and excessive alcohol intake. However, there are promising therapeutic advances, such as the use of mesenchymal stem cells, which could in the future improve the poor joint prognosis of aseptic osteonecrosis. These conservative treatments are recommended at a stage without collapse of the articular surface.


Assuntos
Artroplastia de Quadril , Osteonecrose/cirurgia , Corticosteroides/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Osteonecrose/etiologia
3.
J Am Acad Orthop Surg ; 28(14): 570-584, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692092

RESUMO

Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.


Assuntos
Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Transplante Ósseo , Capitato/cirurgia , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Humanos , Imobilização , Isquemia , Osso Semilunar/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Medição de Risco , Adulto Jovem
4.
Pediatr Blood Cancer ; 67(8): e28336, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32472969

RESUMO

BACKGROUND: Osteonecrosis is a debilitating complication in children and adolescents with acute lymphoblastic leukemia or acute lymphoblastic lymphoma (LLy). An objective screening test to identify patients at risk for symptomatic, extensive joint involvement will help manage osteonecrosis. METHODS: We performed a prospective, longitudinal pilot study with whole-joint magnetic resonance imaging (MRI) of shoulders, elbows, hips, knees, ankles, and hindfeet to evaluate the incidence and timing of osteonecrosis involving multiple joints in 15 patients with LLy aged 9-21 years at diagnosis. RESULTS: Osteonecrosis affecting ≥30% of the epiphysis occurred in eight of 15 patients, with a high prevalence in hips (12 of 26 examined [46%]) and knees (10 of 26 [38%]) post reinduction I and in shoulders (seven of 20 [35%]) post reinduction II. Most osteonecrotic hips and knees with ≥30% epiphyseal involvement became symptomatic and/or underwent surgery (100% and 82%, respectively). All eight patients with ≥30% epiphyseal involvement had multijoint involvement. Seven of these patients had hip or knee osteonecrosis by the end of remission induction, and only these patients developed osteonecrosis that became symptomatic and/or underwent surgery in their hips, knees, shoulders, ankles, and/or feet; all of these joints were associated with epiphyseal abnormalities on post reinduction I imaging. CONCLUSIONS: MRI screening in adolescent patients with LLy revealed osteonecrosis in multiple joints. Initial screening with hip and knee MRI at the end of induction may identify susceptible patients who could benefit from referrals to subspecialties, more extensive follow-up imaging of other joints, and early medical and surgical interventions.


Assuntos
Articulações/diagnóstico por imagem , Imagem por Ressonância Magnética , Osteonecrose , Leucemia-Linfoma Linfoblástico de Células Precursoras , Adolescente , Criança , Feminino , Humanos , Incidência , Masculino , Osteonecrose/diagnóstico , Osteonecrose/epidemiologia , Osteonecrose/cirurgia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Fatores de Risco
5.
Acta Orthop Traumatol Turc ; 54(1): 66-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175899

RESUMO

OBJECTIVE: The aim of this study was compare the clinical success of treatments for avascular necrosis and osteochondritis dissecans in cases who underwent matrix autologous chondrocyte implantations, and evaluate cartilage thickness on the clinical outcomes after implantation. METHODS: A total of 37 patients (29 men, and 8 women; mean age: 23.8 years (16-38)) were treated prospectively with a two-stage matrix autologous chondrocyte implantation (avascular necrosis, n=21; osteochondritis dissecans, n=18). Clinical improvements and follows-up were assessed based on the patients' International Cartilage Repair Society (ICRS) scores with simultaneous cartilage thickness measurement using short-TI inversion recovery magnetic resonance imaging. The patients were divided into four subgroups based on their clinical scores, as group D <65 points, Group C 65-83 points, Group B 84-90 and Group A ≥90. RESULTS: The mean ICRS score was 28.33±7.14 in the preoperative period in the avascular necrosis group, which increased to 70.88±12.61 at 60 months; while the mean ICRS score increased from 29.75±7.15 preoperatively to 87.58±12.83 at 60 months in the osteochondritis dissecans group. A statistically significant difference in the ICRS scores was noted between the two groups, and also between the ICRS scores and cartilage thicknesses of the subgroups (p<0.05). CONCLUSION: Our study results revealed that greater clinical improvement was achieved in patients with osteochondritis dissecans undergoing matrix autologous chondrocyte implantation than in those with avascular necrosis. In addition, cartilage thickness greater than 3.7 mm following an autologous chondrocyte transplantation showed excellent clinical improvement. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Condrócitos/transplante , Osteocondrite Dissecante/cirurgia , Osteonecrose/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Procedimentos Ortopédicos/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Transplante Autólogo/métodos
6.
J Pediatr Orthop ; 40(4): 168-175, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32132446

RESUMO

BACKGROUND: Two operative procedures are currently advocated to stimulate the necrotic femoral head healing in children with Legg-Calve-Perthes disease: transphyseal neck-head tunneling (TNHT) and multiple epiphyseal drilling (MED). The purpose of this study was to compare the bone healing and physeal function after treatment with TNHT or MED in a piglet model of ischemic osteonecrosis. METHODS: Eighteen piglets were induced with osteonecrosis by surgically placing a ligature tightly around the right femoral neck. One week later, the piglets were assigned to 1 of 3 treatment groups (n=6/group): (1) local nonweight bearing only (NWB), (2) TNHT plus NWB, or (3) MED plus NWB. The unoperated left femoral heads were used as normal controls. The animals were euthanized at 8 weeks after osteonecrosis induction. Histologic, histomorphometric, radiographic, microcomputed tomography (CT), and calcein-labeling assessments were performed. Statistical analysis included a 1-way ANOVA. RESULTS: Micro-CT analyses showed higher femoral head bone volume in the MED group compared with the TNHT and the NWB groups (P<0.01). The MED group had a higher mean trabecular number (P<0.001) and new bone formation (P=0.001) based on calcein-labeling parameters compared with the TNHT and the NWB groups. In addition, the osteoclast number per bone surface was lower in the MED group compared with the NWB group (P=0.001). Histologic and micro-CT assessments of the proximal femoral physis revealed a larger physeal disruption at the site of physeal drilling in the TNHT group compared with the MED group. However, no significant differences in physeal elongation (P=0.61) and femoral neck length (P=0.31) were observed between the treatment groups. CONCLUSIONS: MED produced a higher bone volume and stimulated greater bone formation than the TNHT or the NWB alone. Both procedures did not produce a significant physeal growth disturbance during the study period. CLINICAL RELEVANCE: This preclinical study provides evidence that MED produces more favorable bone healing than the TNHT in a large animal model of Legg-Calve-Perthes disease.


Assuntos
Cabeça do Fêmur , Doença de Legg-Calve-Perthes , Procedimentos Ortopédicos/métodos , Osteonecrose , Animais , Modelos Animais de Doenças , Epífises/patologia , Epífises/cirurgia , Cabeça do Fêmur/irrigação sanguínea , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/cirurgia , Lâmina de Crescimento/patologia , Lâmina de Crescimento/cirurgia , Humanos , Doença de Legg-Calve-Perthes/patologia , Doença de Legg-Calve-Perthes/cirurgia , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteonecrose/cirurgia , Suínos , Resultado do Tratamento , Cicatrização , Microtomografia por Raio-X/métodos
7.
Phys Ther ; 100(3): 509-522, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32044966

RESUMO

BACKGROUND: Glucocorticoids used to treat childhood leukemia and lymphoma can result in osteonecrosis, leading to physical dysfunction and pain. Improving survival rates warrants research into long-term outcomes among this population. OBJECTIVE: The objective of this study was to compare the physical function and quality of life (QOL) of survivors of childhood cancer who had an osteonecrosis history with that of survivors who had no osteonecrosis history and with that of people who were healthy (controls). DESIGN: This was a cross-sectional study. METHODS: This study included St Jude Lifetime Cohort Study participants who were ≥ 10 years from the diagnosis of childhood leukemia or lymphoma and ≥ 18 years old; 135 had osteonecrosis (52.5% men; mean age = 27.7 [SD = 6.08] years) and 1560 had no osteonecrosis history (52.4% men; mean age = 33.3 [SD = 8.54] years). This study also included 272 people who were from the community and who were healthy (community controls) (47.7% men; mean age = 35.1 [SD = 10.46] years). The participants completed functional assessments and questionnaires about QOL. RESULTS: Survivors with osteonecrosis scored lower than other survivors and controls for dorsiflexion strength (mean score = 16.50 [SD = 7.91] vs 24.17 [SD = 8.61] N·m/kg) and scored lower than controls for flexibility with the sit-and-reach test (20.61 [SD = 9.70] vs 23.96 [SD = 10.73] cm), function on the Physical Performance Test (mean score = 22.73 [SD = 2.05] vs 23.58 [SD = 0.88]), and mobility on the Timed "Up & Go" Test (5.66 [SD = 2.25] vs 5.12 [SD = 1.28] seconds). Survivors with hip osteonecrosis requiring surgery scored lower than survivors without osteonecrosis for dorsiflexion strength (13.75 [SD = 8.82] vs 18.48 [SD = 9.04] N·m/kg), flexibility (15.79 [SD = 8.93] vs 20.37 [SD = 10.14] cm), and endurance on the 6-minute walk test (523.50 [SD = 103.00] vs 572.10 [SD = 102.40] m). LIMITATIONS: Because some eligible survivors declined to participate, possible selection bias was a limitation of this study. CONCLUSIONS: Survivors of childhood leukemia and lymphoma with and without osteonecrosis demonstrated impaired physical performance and reported reduced QOL compared with controls, with those requiring surgery for osteonecrosis most at risk for impairments. It may be beneficial to provide strengthening, flexibility, and endurance interventions for patients who have pediatric cancer and osteonecrosis for long-term function.


Assuntos
Sobreviventes de Câncer , Leucemia/tratamento farmacológico , Linfoma/tratamento farmacológico , Osteonecrose/fisiopatologia , Desempenho Físico Funcional , Qualidade de Vida , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Osteonecrose/induzido quimicamente , Osteonecrose/cirurgia , Amplitude de Movimento Articular , Participação Social , Teste de Caminhada
8.
BMC Musculoskelet Disord ; 21(1): 82, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32033554

RESUMO

BACKGROUND: Kümmell's disease is a special type of osteoporotic vertebral fracture that causes chronic low back pain and deformity, which seriously affects the living quality of patients. PVP is commonly used to treat osteoporotic vertebral fractures and can quickly relieve low back pain. So, the objective of this study was to analyze the clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction for the treatment of Kümmell's disease. METHODS: A retrospective analysis of patients with Kümmell's disease who underwent bipedicular percutaneous vertebroplasty was conducted from February 2016 to May 2018. Operative time, VAS, bone cement injection volume, cement leakage rate, compression improvement of vertebral front edge and vertebral center, and correction degree of kyphosis were collected and analyzed meticulously. RESULTS: The operative time was 45.33 ± 7.64 min. The volume of bone cement injected was 5.38 ± 1.33 ml. The compression improvement of vertebral front edge was 7.31 ± 1.21%. The compression improvement of vertebral center was 10.34 ± 1.15% and the correction degree of kyphosis was - 2.73 ± 0.31゜. Bone cement leakage occurred in 6 of 39 patients (15.38%), but no clinical symptoms were observed. The VAS scores were significantly lower at 1 day after the surgery, 6 months and at the last follow-up than before the surgery (P = 0.000, respectively). The VAS score was lower at the last follow-up than at 1 day after the surgery (P = 0.001). CONCLUSION: Bipedicular percutaneous vertebroplasty combined with postural reduction could achieve satisfactory analgesic effect in the treatment of Kümmell's disease, and restore the height of the vertebral body and improve kyphosis to some extent.


Assuntos
Fixação de Fratura/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteonecrose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/cirurgia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Seguimentos , Fixação de Fratura/efeitos adversos , Humanos , Cifose/diagnóstico , Cifose/etiologia , Cifose/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Osteonecrose/complicações , Osteonecrose/diagnóstico , Medição da Dor , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos
9.
BMC Musculoskelet Disord ; 21(1): 39, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954404

RESUMO

BACKGROUND: Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). METHODS: Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. RESULTS: No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5° lesser LL, 5° greater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7° less, lumbar spine flexion 16° less, L1 slope change 6° less, and SS change 8° less, and hip flexion was 7° more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. CONCLUSIONS: Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.


Assuntos
Artroplastia de Quadril/métodos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Postura/fisiologia , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteonecrose/cirurgia , Postura Sentada , Posição Ortostática
10.
Orthop Clin North Am ; 51(1): 65-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739880

RESUMO

Surgical strategies for scaphoid nonunions become more complex based on time from injury to treatment. The decision-making process, however, can follow a logical sequence. Scaphoid nonunions less than 1 year after trauma and no carpal malalignment can be treated with percutaneous screw fixation under fluoroscopic and/or arthroscopic guidance. Reinterventions or patients with avascular proximal poles that do not need substantial grafts are reliably treated with pedicle vascularized bone grafts. Resection of the distal pole of the scaphoid is a good option in old nonunions or after a failed scaphoid procedures. When there are radioscaphoid degenerative changes, salvage procedures such as proximal row carpectomy (PRC) should be considered.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osteonecrose/cirurgia , Osso Escafoide/lesões , Artroscopia/métodos , Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/classificação , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Osteonecrose/epidemiologia , Osteonecrose/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Estudos Retrospectivos , Osso Escafoide/irrigação sanguínea , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/patologia , Resultado do Tratamento , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem
11.
Arch Pathol Lab Med ; 144(5): 580-585, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31538796

RESUMO

CONTEXT.­: Decisions to perform hip arthroplasty rely on both radiographic and clinical findings. Radiologists estimate degree of osteoarthritis (OA) and document other findings. Arthroplasty specimens are sometimes evaluated by pathology. OBJECTIVE.­: To determine the frequency of pathologic changes not recognized clinically. DESIGN.­: Nine hundred fifty-three consecutive femoral head resections performed between January 2015 and June 2018, with recent radiologic and histologic study, were reviewed. We compared severity of OA reported by radiology and pathology. Findings unrecognized radiographically but recorded pathologically, and discrepancies between clinical diagnosis and pathology diagnosis, were tabulated. RESULTS.­: Twenty-one cases of osteomyelitis were diagnosed radiographically or pathologically. Eight discrepancies were present. Fourteen osteomyelitis cases were recognized clinically. Pathology recognized 2 neoplasms missed radiographically. Avascular necrosis was diagnosed on pathology but not radiology in 25 cases, and 35 cases of avascular necrosis were seen radiographically but not pathologically. Osteoarthritis was graded both radiographically and pathologically from 0 to 3. Five hundred ninety-one of 953 cases (62%) were grade 3. Pathologists and radiologists had perfect agreement in 696 of 953 cases (73%). When grade of OA seen at pathology was correlated with surgeon, 2 groups of surgeons were detected: one with a low threshold for performance of hip arthroplasty (23%-28% low-severity OA) and the second with a high threshold (2%-5% low-severity OA). CONCLUSIONS.­: Correlation between radiology and pathology diagnoses is high. Degree of OA present varies significantly between surgeons. Pathology discloses findings not recognized clinically.


Assuntos
Neoplasias Ósseas/patologia , Osteoartrite/patologia , Osteomielite/patologia , Osteonecrose/patologia , Artroplastia/normas , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Quadril/diagnóstico por imagem , Quadril/patologia , Quadril/cirurgia , Humanos , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Radiografia/normas
12.
J Knee Surg ; 33(3): 294-300, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30736053

RESUMO

There have been many reports on the clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA); however, none have investigated the influence of flexion angle after UKA on clinical outcomes. The objective of this study was to clarify the relationship between outcomes and the postoperative maximum flexion angle and reveal the necessary factors for maximum flexion angle ≥ 140 degrees which is considered necessary for Asian populations. We categorized 212 UKA patients into the following three groups based on the postoperative maximum flexion angle: group 1 had flexion angle ≥ 140 degrees in 80 patients (38%), group 2 had 130 degrees ≤ flexion angle < 140 degrees in 80 patients (38%), and group 3 had flexion angle < 130 degrees in 52 patients (24%). Furthermore, we compared the postoperative clinical outcomes between the three groups and conducted multivariable regression analyses to assess parameters affecting the flexion angle. Postoperative Knee Society function scores for group 1 was significantly higher than for group 3. Group 1 had higher mean knee injury and osteoarthritis outcome scores (KOOS) in all subscales and significantly higher KOOS scores in the sports and quality of life subscales compared with group 2 and in all subscales compared with group 3. Multivariable logistic regression showed that preoperative flexion angle and tibial component posterior slope were associated with maximum flexion angle ≥ 140 degrees. Maximum flexion angle ≥ 140 degrees after Oxford UKA improved the clinical results, particularly for patient-reported outcomes. Furthermore, the tibial posterior slope was an important factor in achieving maximum flexion angle ≥ 140 degrees in UKA patients.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteonecrose/cirurgia , Amplitude de Movimento Articular , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteonecrose/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Qualidade de Vida , Resultado do Tratamento
13.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1551-1559, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31218389

RESUMO

PURPOSE: The aim of this multicentre, retrospective, observational study was to determine the incidence of revision and clinical results of a large cohort of robotic-arm-assisted medial and lateral UKAs at short-term follow-up. It was hypothesized that patients who receive robotic-arm-assisted UKA will have high survivorship rates and satisfactory clinical results. METHODS: Between 2013 and 2016, 437 patients (470 knees) underwent robotic-arm-assisted medial and lateral UKAs at two centres. Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score 12 (FJS-12) and Short-Form Physical and Mental Health Summary Scales (SF-12) were administered to estimate patients' overall health status pre- and post-operatively. Results were dichotomized as 'excellent' and 'poor' if KOOS/FJS-12 were more than or equal to 90 and SF-12 was more or equal to 45. Associations between patients' demographic characteristics and clinical outcomes were investigated. Post-operative complications and pain persistence were recorded. RESULTS: Following exclusions and losses to follow-up, 338 medial and 67 lateral robotic-arm-assisted UKAs were assessed at a mean follow-up of 33.5 and 36.3 months, respectively. Three medial UKAs were revised, resulting in a survivorship of 99.0%. No lateral implants underwent revision (survivorship 100%). On average, significant improvement in all clinical scores was reported in both medial and lateral UKA patients. In medial UKA patients, male gender was associated with higher probability of better scores in overall KOOS, FJS-12 and in specific KOOS subscales. No other associations were reported between biometric parameters and outcome for either medial or lateral UKA. CONCLUSIONS: Robotic-assisted medial and lateral UKAs demonstrated satisfactory clinical outcomes and excellent survivorship at 3-year follow-up. Continued patient follow-up is needed to determine the long-term device performance and clinical satisfaction. LEVEL OF EVIDENCE: Retrospective cohort study, Level IV.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
14.
Skeletal Radiol ; 49(1): 147-154, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31139921

RESUMO

Avascular necrosis (AVN) of the bone is thought to be a serious complication of treatment for acute lymphoblastic leukemia (ALL). The acetabulum is an unusual area to be affected by AVN, and there are currently no reports of successful joint salvage procedures found in the literature. We present a case of a 20-year-old man with ALL who was diagnosed with debilitating AVN of both acetabula 2 years following initial diagnosis of ALL and treatment with a multi-agent chemotherapy regimen including high-dose corticosteroids. After unsuccessful treatment with bisphosphonate therapy, the acetabular AVN underwent bilateral curettage and impaction bone grafting to prevent collapse of subchondral fractures with the hope of salvaging both hip joints. Computer tomography (CT) of the AVN affected areas, pre- and post-bone impaction grafting, demonstrated healing of the subchondral fractures and a doubling of bone density that was maintained at 2 years after surgery. The patient resumed full weight-bearing at 3 months after first surgery, continues to ambulate unrestricted, and remains pain free 3 years post-surgery.


Assuntos
Acetábulo/diagnóstico por imagem , Transplante Ósseo/métodos , Fraturas Ósseas/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Acetábulo/lesões , Acetábulo/patologia , Acetábulo/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Densidade Óssea , Curetagem , Difosfonatos/uso terapêutico , Consolidação da Fratura , Fraturas Ósseas/induzido quimicamente , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/cirurgia , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Osteonecrose/induzido quimicamente , Osteonecrose/tratamento farmacológico , Osteonecrose/cirurgia , Prednisolona/efeitos adversos , Prednisolona/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 1827-1834, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31273409

RESUMO

PURPOSE: The study aimed to evaluate the optimal timing for plate removal after open-wedge high tibial osteotomy (OWHTO) without loss of correction and to investigate risk factors for loss of correction after plate removal. The study presents the hypothesis that plate removal without loss of correction was possible when gap filling reached zone 2 (25-50%) on anteroposterior radiographs. METHODS: Ninety-one patients (101 knees) who underwent OWHTO using the TomoFix® plate were enrolled. Plate removal was performed at an average 16.4 ± 5.4 months after OWHTO. Clinical evaluation included plate-related symptoms, the Japanese Orthopedic Association Knee Score (JOA score), and Oxford Knee Score (OKS). Radiological outcomes, including the hip-knee-ankle angle (HKA), weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS), were evaluated preoperatively, at plate removal and at 1 year after plate removal. Computed tomography (CT) was performed at plate removal to evaluate the flange bone union, progression rates of gap filling, and posterior cortex bone union. In addition, the risk factors for loss of correction after plate removal were evaluated. RESULTS: At plate removal, 63 (62.4%) knees had plate-related symptoms (mild, 56 knees; moderate, 7 knees; severe, 0). After plate removal, the JOA score did not change, whereas OKS further improved; six knees developed loss of correction. On CT evaluation at plate removal, the flange bone union was achieved in all cases; the progression rates of gap filling and posterior cortex bone union were 47.0% ± 16.6% and 62.8% ± 16.5%, respectively. A posterior cortex union rate of < 43.3% was the only predictor for loss of correction after plate removal (odds ratio: 1.38, P < 0.01). CONCLUSIONS: Plate removal without loss of correction after OWHTO was possible when bone union of the posterior cortex reached the center of the osteotomy gap even in incompletely filled gaps. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.


Assuntos
Placas Ósseas , Osso Cortical/fisiologia , Remoção de Dispositivo , Osteogênese , Osteotomia/instrumentação , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Osso Cortical/diagnóstico por imagem , Osso Cortical/cirurgia , Progressão da Doença , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Osteonecrose/fisiopatologia , Osteonecrose/cirurgia , Radiografia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/fisiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1479-1487, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31209540

RESUMO

PURPOSE: Unicompartmental knee replacement (UKR) has substantial benefits over total knee replacement (TKR) but has higher revision rates. The cementless Oxford UKR was introduced to address this but there are concerns about fixation and tibial plateau fractures. The first long-term study of the device with clinical and radiographic outcomes is reported. METHODS: The first 1000 medial cementless Oxford UKR were prospectively identified and followed up by independent physiotherapists. Survival was calculated using the endpoints reoperation, revision, revision to TKR, major revision requiring revision TKR components and patient mortality. The Oxford Knee Score (OKS), Tegner Activity Score and American Knee Society Score (AKSS) were recorded and radiographs analysed. RESULTS: The ten year survival was 96.6% (CI 94.8-97.8), 97.5% (CI 95.7-98.5), 98.9% (CI 97.7-99.4) and 99.6% (CI 98.8-99.9) using reoperation, revision, revision to TKR and major revision as the endpoint, respectively. Commonest causes for revision were bearing dislocation (n = 7, 0.7%), disease progression (n = 4, 0.4%) and pain (n = 2, 0.2%). There was one lateral tibial plateau fracture and one femoral component loosening. At 10 years, the mean OKS was 41.2 (SD 9.8), Tegner 2.8 (SD 1.3), AKSS-O 89.1 (SD 13.0) and AKSS-F 80.4 (SD 14.6). There were no pathological radiolucencies or complete radiolucent lines. There were no implant-related deaths. CONCLUSIONS: The cementless Oxford UKR is a safe procedure with excellent long-term clinical results. Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening (femoral), no radiographic evidence of loosening in the remaining cases and no fractures related to implantation. LEVEL OF EVIDENCE: III.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Artroplastia do Joelho/métodos , Cimentação , Progressão da Doença , Feminino , Seguimentos , Humanos , Prótese do Joelho , Escore de Lysholm para Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Desenho de Prótese , Falha de Prótese
17.
J Surg Orthop Adv ; 29(4): 244-248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33416486

RESUMO

Avascular necrosis (AVN) of the talus remains a clinical challenge with suboptimal outcomes after treatment. In cases of extensive disease, the insufficient blood supply leads to a high rate of complications including non-union after surgical treatment. This, in conjunction with the development of premature adjacent arthritis represents a challenge for the treating surgeon. Nowadays, total ankle arthroplasty is a reasonable option for the treatment of end-stage ankle arthritis with improved short- and long-term outcomes. We present a technique for patients with end-stage ankle arthritis associated to extensive talar osteonecrosis, and patients with prior total ankle replacement and talar component collapse due to AVN. This technique provides a more anatomic treatment for patients with severely deficient bone stock due to talar necrosis with ankle arthritis or failed ankle replacement. Nonetheless, evaluation of the outcomes at long-term is needed. (Journal of Surgical Orthopaedic Advances 29(4):244-248, 2020).


Assuntos
Artroplastia de Substituição do Tornozelo , Osteonecrose , Tálus , Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Humanos , Osteonecrose/cirurgia , Tálus/diagnóstico por imagem , Tálus/cirurgia
18.
J Craniomaxillofac Surg ; 47(12): 1918-1921, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812305

RESUMO

Krokodil is a cheap and effective home-made substitute for heroin. It is widely used over the territory of the former USSR (Russia, Ukraine, Armenia and others). Krokodil drug-related midface ON often occurs as a complication of maxillary ON. Treatment of Krokodil drug-related ON of the midface is challenging. It is difficult to determine the ON zone preoperatively and intraoperatively, due to the complex anatomy of the midface and the different periods of the disease onset in different areas. The aim of this study is to show variations of the clinical course and treatment options of Krokodil drug-related ON of the midface. In this study, 3 cases of Krokodil drug-related midface ON are reported. The main clinical feature of midface ON is extraoral fistula in the midfacial zone with purulent discharge or extraoral exposure of zygomatic bone. Surgery is the main treatment method for Krokodil drug-related midface osteonecrosis. Surgery includes necrotic bone removal and defect closure. Usually an extraoral approach is used to expose necrotic bone. Intraoral maxillary sinus floor defect is closed with the use of a buccal fat pad to prevent formation of oroantral communication. Drug withdrawal, radical necrectomy, and proper closure of formed defects are the main factors that lead to successful treatment of Krokodil drug-related midface ON patients.


Assuntos
Codeína/análogos & derivados , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/química , Necrose/induzido quimicamente , Osteonecrose/induzido quimicamente , Levantamento do Assoalho do Seio Maxilar , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Codeína/efeitos adversos , Codeína/química , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Necrose/cirurgia , Osteonecrose/cirurgia , Resultado do Tratamento
19.
Hematology Am Soc Hematol Educ Program ; 2019(1): 351-358, 2019 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-31808856

RESUMO

Osteonecrosis, a form of ischemic bone injury that leads to degenerative joint disease, affects ∼30% of people with sickle cell disease. Although osteonecrosis most commonly affects the femoral head (often bilaterally, with asymmetric clinical and radiographic progression), many people with sickle cell disease also present with multifocal joint involvement. We present the case of a young woman with bilateral osteonecrosis of the femoral head at varying stages of progression; we also highlight other important comorbid complications (eg, chronic pain requiring long-term opioids, debility, and social isolation) and postoperative outcomes. In this review, partly based on recommendations on osteonecrosis management from the 2014 evidence-based report on sickle cell disease from the National Heart, Lung and Blood Institutes, we also discuss early signs or symptoms of osteonecrosis of the femoral head, radiographic diagnosis and staging criteria, hydroxyurea effect on progression to femoral head collapse, and surgical outcomes of total hip arthroplasty in the modern era. In summary, we failed to find an association between hydroxyurea use and femoral head osteonecrosis; we also showed that evidence-based perioperative sickle cell disease management resulted in superior postoperative outcomes after cementless total hip arthroplasty in sickle cell-related osteonecrosis of the femoral head.


Assuntos
Osteonecrose/diagnóstico , Osteonecrose/epidemiologia , Adolescente , Anemia Falciforme/complicações , Criança , Feminino , Humanos , Hidroxiureia/uso terapêutico , Pessoa de Meia-Idade , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Prevalência , Prognóstico , Fatores de Risco , Adulto Jovem
20.
Acta Biomed ; 90(12-S): 64-68, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31821286

RESUMO

OBJECTIVES: The purpose of this study is to evaluate the clinical and radiological outcomes of scaphoid non unions surgically treated with bone graft versus medial condyle corticoperiosteal free flaps. MATERIALS AND METHODS: 32 patients were divided in 2 groups. Group A (17 patients 12male, 5 females, mean age 35 years old) treated with bone grafts; Group B (15patients 11 male, 4 females, mean age 33 years old) treated with medial condyle cortico periosteal free flap. A radiological follow up was performed about every 30 days after surgery until the complete healing and at 12-month follow-up. The clinical follow up was performed at 6 and 12 months from surgery. Functional assessment was provided by Mayo wrist score and Visual Analogic Scale (VAS). RESULTS: The average length of follow up was 12.52 months ± 1.36. In group A 60% of patients healed in 4.4 ± 1months with a reduction of 28.4% of healing times in group B (p<0.05).In Group B all nonunion sites healed primarily at an average time period of 3.2 ± 1 months. Statistical analysis showed a significant difference (p<0.001) about the preoperative and the postoperative VAS and Mayo Wrist Score evaluation in both groups at 6 and 12-month follow-up, moreover we recorded a statistical difference between groups at the 6-month and 12-month follow-up (p<0.05). CONCLUSION: The present study showed that the free flaps showed better clinical and radiographic results for the surgical treatment of scaphoid nonunions. In fact, despite the good results of the bone graft, the flaps seems to be preferable in the treatment of these nonunions.


Assuntos
Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Osteonecrose/cirurgia , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Feminino , Seguimentos , Fraturas não Consolidadas/complicações , Humanos , Masculino , Osteonecrose/complicações , Estudos Retrospectivos , Resultado do Tratamento
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