ABSTRACT
BACKGROUND: Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. METHODS: Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. RESULTS: The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up (p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II (p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively (p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. CONCLUSIONS: The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of squeaking (1 of 8 hips) was higher, as compared to the control group or previously reported values.
Subject(s)
Adult , Humans , Male , Arthroplasty, Replacement, Hip/adverse effects , Case-Control Studies , Decompression, Surgical/adverse effects , Femur Head/diagnostic imaging , Femur Head Necrosis/diagnostic imaging , Postoperative Complications , Reoperation , Retrospective Studies , Tantalum/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objectives: To evaluate short-term clinical results of patients performed acetabular revision surgery using a Trabecular Tantalum coated modular acetabular cups. Materials and Methods: This is a retrospective and descriptive analysis of a serie of 32 consecutive patients (34 hips) with acetabular revision surgery (23 women, 9 men, mean age 70.7 years), mean follow-up 32 month (12-60). The Paprosky and the AAOS acetabular defects classifications were assessed. According to Paprosky acetabular defects classification, there were eleven type I, two IIA, three IIB, nine IIC, seven IIIA and two IIIB. According to AAOS acetabular defects classification there were thirteen patients with type 1, nine patients with type 2, ten type 3 and two type 4. The percentage of own acetabular bone in contact with the new cup was recorded for each patient at the time of surgery and was 45 percent (range from 20 to 80 percent), with 23 patients presenting less than 50 percent of bone contact (mean 35 percent). Postoperatively, osseous integration was radiographically assessed. Functional results were evaluated according to the Harris Hip Score (HSS). The complications related to the implant were also recorded. Results: In all radiographic assessments performed at 3, 6 and 12 month postoperatively an integrated cup without signs of migration or osteolysis was observed. Four patients (11.8 percent) presented recurrent hip dislocation that required a revision surgery without further cup revision. The final clinical assessment was performed at a mean of 26 month after surgery (12-60) with a mean HHS of 91.8 points. Conclusion: Trabecular tantalum coated modular acetabular cups in acetabular revision surgery shows good short term clinical results even with acetabular defects greater than 50 percent. No cup loosening was observed in these series.
Objetivo: Evaluar los resultados clínicos a corto plazo de pacientes sometidos a cirugía de revisión acetabular utilizando cotilos modulares con superficie de metal trabecular de tantalio. Material y Métodos: Estudio retrospectivo-descriptivo de una serie consecutiva de 32 pacientes (34 caderas) sometidos a cirugía de revisión acetabular (23 mujeres, 9 hombres, edad promedio 70,7 años), seguimiento promedio 32 meses (12-60). Se clasifican los defectos acetabulares de acuerdo ala clasificación de Paprosky y de la AAOS. Según la clasificación de Paprosky de los defectos acetabulares, 11 pacientes tenían categoría I, 2 categoría IIA, 3 categoría IIB, 9 categoría IIC, 7 categoría IIIA y 2 categoría IIIB. Según la clasificación de la AAOS, 13 pacientes correspondieron a nivel 1, 9 pacientes a nivel 2, 10 a nivel 3 y 2 a nivel 4. Se registra el porcentaje de hueso propio acetabular en contacto con el nuevo cotilo de cada paciente que fue en promedio 45 por ciento (20-80 por ciento), presentándose en 23 caderas un porcentaje < 50 por ciento, el cual fue en promedio 35 por ciento. En el postoperatorio se evalúa la integración ósea mediante radiografías de pelvis. Se evalúan los resultados funcionales mediante el HHS (Harris Hip Score) y las complicaciones postoperatorias relacionadas con el implante. Resultados: En todas las radiografías postoperatorias realizadas a los 3, 6 y 12 meses se evidenciaba el cotilo integrado, sin signos de migración ni osteolisis. Cuatro pacientes (11,8 por ciento) presentaron luxaciones recidivantes de cadera, las cuales requirieron de una cirugía de revisión sin recambio del cotilo. La última evaluación clínica fue en promedio 26 meses tras la cirugía (12-60 meses) constatándose un HHS promedio de 91,8 puntos. Conclusión: El uso de cotilos modulares con revestimiento de metal trabecular de tantalio en cirugías de revisión acetabular presenta buenos resultados clínicos a corto plazo incluso en defectos óseos acetabulares superiores...
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Acetabulum , Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/methods , Hip Prosthesis , Tantalum/therapeutic use , Follow-Up Studies , Osseointegration , Reoperation , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Ciertas afecciones raquídeas son responsables de dolores y/o de complicaciones neurológicas secundarias al aplastamiento vertebral que ellas producen. Con el fin de consolidar la vértebra y aliviar el dolor surge la Vertebroplastia Acrílica Percutánea, que consiste en la inyección de cemento acrílico por vía percutánea, propuesta inicialmente en el tratamiento de los angiomas vertebrales agresivos. Luego de realizar una punción biopsia de la vértebra, se inserta una aguja de 10 G en el cuerpo vertebral y se inyectan una mezcla de polvo de tantalio y de metil-metacrilato (3 a 5 ml). Fueron tratados exitosamente con este método 31 pacientes portadores de hemangiomas vertebrales y 10 pacientes con dolores severos debidos al aplastamiento vertebral de origen osteoporótico. Siendo el resultado clínico y radiológico estable con un seguimiento de 6 años para los angiomas vertebrales y de 30 meses en 7 pacientes tratados con osteoporosis. Un efecto analgésico significativo permitió desarrollar una actividad normal a 12 pacientes de los 20 tratados con tumores vertebrales. El efecto analgésico fue durable en 10 de ellos con un seguimiento de 6 meses