ABSTRACT
SUMMARY: Refixation of the damaged acetabular labrum is a method of surgical treatment of the hip joint that can promote the repair of joint function after injury and prevent premature osteoarthritis. We sought to determine the condition of the hip joint in rabbits 4 months after excision of the acetabular labrum and the condition of the joint after labral refixation. The articular cartilage of the femoral head and acetabulum was examined by histological methods, multipoint measurement of cartilage thickness, and the ratio between cartilage matrix and chondrocytes lacunae, and the condition of cartilage according to the OARSI grading scale was carried out. On this model, a correlation analysis was performed between the results of the OARSI grading scale and the data of linear morphometry. All these parameters made it possible to better assess changes in articular cartilage. The ratio between matrix and chondrocyte lacunae turned out to be a method that allows establishing early cartilage damage when erosion, fibrosis or deformation did not occur. We found significant differences between the condition of the cartilage after exicion of acetabular labrum and after labral refixation, which give hope to confirm that this surgical technique can delay or prevent progressive changes in the cartilage of the damaged hip joint.
La refijación del labrum acetabular dañado es un método de tratamiento quirúrgico de la articulación coxal, que puede promover la reparación de la función articular después de una lesión y prevenir la osteoartritis prematura. Intentamos determinar el estado de la articulación coxal en conejos de 4 meses después de la escisión del labrum acetabular y observar el estado de la articulación después de la refijación del labrum. El cartílago articular de la cabeza femoral y el acetábulo se examinó por métodos histológicos, se midió a través de multipunto el grosor del cartílago y se realizó la relación entre la matriz del cartílago y las lagunas de condrocitos, y se llevó a cabo la condición del cartílago según la escala de clasificación OARSI. Sobre este modelo se realizó un análisis de correlación entre los resultados de la escala de calificación OARSI y los datos de la morfometría lineal. Todos estos parámetros permitieron evaluar mejor los cambios en el cartílago articular. La relación entre la matriz y las lagunas de condrocitos resultó ser un método que permite establecer temprano el daño del cartílago cuando no se presentó erosión, fibrosis o deformación. Encontramos diferencias significativas entre la condición del cartílago después de la extirpación del labrum acetabular y después de la refijación del labrum, lo que da la esperanza de confirmar que esta técnica quirúrgica puede retrasar o prevenir cambios progresivos en el cartílago de la articulación coxal dañada.
Subject(s)
Animals , Rabbits , Cartilage, Articular , Femur Head , Hip Joint , Acetabulum/surgeryABSTRACT
Abstract Objective We investigated the effect of disease stage, patient's age and final contour of femoral head on acetabulum contour following varus derotation osteotomy of proximal femur (VDRO) in unilateral Perthes's disease. Methods The study is a retrospective analysis of case records of 23 children aged ≥6 years with unilateral Perthes' disease who underwent primary VDRO procedure for containment. Acetabular index (AI) and center edge angle (CEA) were calculated bilaterally in preoperative and follow-up radiographs and compared statistically. Results There were 15 boys and 8 girls. Six hips were in Ib, 8 in IIa and 9 in IIb modified Waldenström stage while undergoing VDRO. The mean age at surgical intervention was 8.7 years. The mean follow-up duration was 3.5 years. All femoral heads were healed at final follow-up and the final Stulberg grades were I = 3, II = 8, III = 7, IV = 5. A significant acetabular dysplasia on the affected side was present preoperatively. At follow-up, the patients operated had significantly raised AI and reduced CEA. There was no significant acetabular remodeling of the affected hips at follow-up even in children operated at younger age (< 8 years) or early stages (stage Ib or IIa). The acetabulum remodeling did not correspond to the final Stulberg grade as well. Conclusion Acetabulum was found involved in early stages of Perthes' disease. Varus derotation femoral osteotomy for the diseased hip showed no significant improvement in acetabular dysplasia even when operated in early disease stages or younger age group. Residual acetabular changes were also noted even with favorable Stulberg grades.
Resumo Objetivo Investigamos o efeito do estágio da doença, idade do paciente e contorno final da cabeça femoral no contorno do acetábulo após a osteotomia derrotatória varizante (VDRO) do fêmur proximal na doença de Perthes unilateral. Métodos O estudo é uma análise retrospectiva de prontuários de 23 crianças com idade ≥ 6 anos com doença de Perthes unilateral que foram submetidas ao procedimento primário de VDRO para contenção. O índice acetabular (AI) e o ângulo da borda central (CEA) foram calculados bilateralmente em radiografias pré-operatórias e de acompanhamento e submetidos à comparação estatística. Resultados Os pacientes eram 15 meninos e oito meninas. À VDRO, seis quadris estavam no estágio de Waldenström modificado Ib, oito no estágio IIa e nove no estágio IIb. A média de idade à intervenção cirúrgica foi de 8,7 anos. A duração média do acompanhamento foi de 3,5 anos. Todas as cabeças femorais estavam consolidadas no último acompanhamento e os graus finais de Stulberg foram I = 3, II = 8, III = 7 e IV = 5. Havia displasia acetabular significativa do lado acometido no período pré-operatório. No acompanhamento, os pacientes operados apresentaram elevação significativa de AI e redução de CEA. Não houve remodelamento acetabular significativo nos quadris acometidos durante o acompanhamento, mesmo em crianças operadas em idade menor (< 8 anos) ou estágios iniciais (estágio Ib ou IIa). O remodelamento do acetábulo também não correspondeu ao grau final de Stulberg. Conclusão A VDRO do fêmur do quadril acometido não levou à melhora significativa da displasia acetabular, mesmo quando a cirurgia foi realizada nos estágios iniciais da doença ou em pacientes mais jovens. Alterações acetabulares residuais também foram observadas mesmo com graus de Stulberg favoráveis.
Subject(s)
Humans , Male , Female , Child , Hip Joint , Legg-Calve-Perthes Disease/surgery , Acetabulum/surgeryABSTRACT
Se presenta a un paciente de 73 años que había sido sometido a dos revisiones de prótesis de cadera debido a una infección crónica por un microorganismo multirresistente. Acude a nuestro centro tras un primer tiempo quirúrgico. En la radiografía simple y la tomografía computarizada, se observan un defecto femoral tipo IV y un defecto acetabular tipo IIIA de Paprosky. Tras un control clínico y análisis de laboratorio, se decide la reconstrucción acetabular mediante un implante "personalizado" y un vástago tumoral. A los 2 años, el paciente evoluciona favorablemente: deambula con bastón y sin dolor. El implante está estable y en posición normal, no hubo recidiva infecciosa. Nivel de Evidencia: IV
We present the case of a 73-year-old patient, previously treated with two hip prosthesis revisions due to a chronic infection caused by a multidrug-resistant microorganism, who consulted after the first surgical procedure. Radiographic and computed tomography studies revealed a Paprosky type IV femoral defect and a type IIIA acetabular defect. Following clinical and laboratory monitoring, it was decided to perform acetabular reconstruction using a custom-made implant and a tumor stem. Two years later, the patient shows a favorable evolution: he is able to walk with a cane and without pain. The implant is stable and properly positioned, with no recurrent infection. Level of Evidence: IV
Subject(s)
Aged , Prostheses and Implants , Reoperation , Arthroplasty, Replacement, Hip , Acetabulum/surgeryABSTRACT
Las fracturas acetabulares con compromiso del cartílago trirradiado (CTR) en pacientes pediátricos son muy poco frecuentes, difíciles de diagnosticar y complejas de tratar; pudiendo dejar graves secuelas. Generalmente son producto de accidentes de tránsito de alta energía cinética. Debido a su baja prevalencia no hay grandes series en la bibliografía y por ende tampoco existe un consenso terapéutico. Realizamos una puesta a punto del tema a propósito de un atípico caso de una niña de 9 años con una fractura del acetábulo con compromiso del CTR, producido por un traumatismo de baja energía cinética. Registramos su diagnóstico y tratamiento quirúrgico, evaluamos su resultado clínico - radiológico y funcional mediante el Hip Harris Score (HHS) al final de su seguimiento de 5 años.
Acetabular fractures with compromise of the triradiate cartilage (TRC) in pediatric patients are very rare, difficult to diagnose and complex to treat, also can leave serious consequences. They are generally product of high energy kinematics. Due to its low prevalence, there are no large series in the literature and therefore there is no therapeutic consensus. We carried out a recapitulation of the subject regarding an atypical case of a 9-year-old girl with an acetabulum fracture with compromise of the TRC, produced by a low kinetic energy trauma. We recorded the diagnosis and surgical treatment, and also, we evaluated the clinical-radiological and functional results through the Hip Harris Score (HHS) at the end of their 5-year follow-up.
As fraturas acetabulares com compromisso da cartilagem trirradiada (TRC) em pacientes pediátricos são muito poco frecuentes, de difícil diagnóstico e complexas de tratar; e podem deixar sérias consequências. Geralmente são o produto de acidentes de trânsito de alta energia cinética. Devido à sua baixa prevalência, não há grandes séries na literatura e, portanto, não há consenso terapêutico. Realizamos uma atualização do tema referente a um caso atípico de uma menina de 9 anos com fratura de acetábulo com comprometimento do CTR, produzida por um trauma de baixa energia cinética. Registramos seu diagnóstico e tratamento cirúrgico, avaliamos seus resultados clínico-radiológicos e funcionais por meio do Hip Harris Score (HHS) ao final de seu seguimento de 5 anos.
Subject(s)
Humans , Female , Child , Acetabulum/surgery , Acetabulum/injuries , Treatment Outcome , Fractures, Bone/surgery , Fractures, Bone/diagnostic imaging , Fracture FixationABSTRACT
OBJECTIVE@#To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI).@*METHODS@#The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint.@*CONCLUSION@#Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.
Subject(s)
Humans , Femoracetabular Impingement/surgery , Arthroscopy/methods , Hip Joint/surgery , Acetabulum/surgery , Hip Dislocation, Congenital/surgery , Treatment Outcome , Retrospective StudiesABSTRACT
OBJECTIVE@#To investigate whether the anteversion angle of acetabular prosthesis can be evaluated on the anteroposterior X-ray film of common double hip joint.@*METHODS@#Total 32 patients(41 hips) after total hip arthroplasty were selected, including 18 males and 14 females, aged(66.2±4.1) years. All patients completed the positive X-ray film of both hips and plain CT scan of pelvis after operation. Acetabular anteversion was measured by plain CT scan of pelvis, and measured by Saka and other measurement formulas on X-ray film.@*RESULTS@#The acetabular anteversion measured by X-ray film was(16.2±5.0)° and that measured by CT was (31.8±9.7)°(P=0.00). In addition, there was a significant linear correlation between X-ray film and CT(Pearson correlation coefficient (r=0.84, P=0.00).@*CONCLUSION@#CT can accurately measure the acetabular anteversion, but it has obvious disadvantages, such as large radiation, high cost, phantom CT artifact and so on. Although Saka measurement formula can not directly obtain the accurate acetabular anteversion as CT measurement, it has a high correlation with the acetabular anteversion measured by CT. Therefore, the method proposed in this study can also preliminarily evaluate the acetabular anteversion.
Subject(s)
Female , Humans , Male , Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Hip Joint/surgery , Hip Prosthesis , PelvisABSTRACT
Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.
Subject(s)
Humans , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Developmental Dysplasia of the Hip , Hip Dislocation/surgery , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate the clinical effect of porous tantalum Jumbo cup on acetabular reconstruction in revision of total hip arthroplasty.@*METHODS@#From September 2014 to December 2017, 18 patients(18 hips) with acetabular defect were reconstructed by porous tantalum Jumbo cup technology, including 6 males and 12 females;the age ranged from 54 to 76 years old with an average of(63.8±15.3) years. There were 6 cases of paprosky typeⅡA, 8 cases of typeⅡB, 2 cases of typeⅡC and 2 cases of type Ⅲ a. Harris score and visual analogue scale (VAS) were performed before and after operation. Imaging examination was performed to evaluate the position of hip rotation center and prosthesis, and to judge whether acetabular loosening, displacement and complications existed.@*RESULTS@#All cases were followed up for 13 to 49 months, with an average of 20.6 months. Harris score increased from 54.6±4.7 to 86.5±3.2 one year after operation(P<0.01), and VAS score decreased from 6.8±0.7 to 0.8±0.6 one year after operation (P<0.01). The transverse coordinate of hip rotation center was (3.52±0.72) cm before operation and (3.47±0.54) cm after operation (P>0.05). The longitudinal coordinate of hip rotation center was improved from (3.02±0.84) cm before operation to (2.35±0.53) cm after operation (P<0.01). During the follow-up period, the Jumbo cup was well fixed without loosening and displacement, the acetabular cup had bone ingrowth in varying degrees, and no light transmission line and osteolysis around the acetabular cup were found. No complications such as infection and nerve injury occurred.@*CONCLUSION@#The method of reconstructing acetabular bone defect with porous tantalum Jumbo cup is simple and easy, the early stability of acetabulum is good, and the short-term follow-up effect is good.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Follow-Up Studies , Hip Prosthesis , Porosity , Prosthesis Failure , Reoperation , Retrospective Studies , Tantalum , Treatment OutcomeABSTRACT
Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.
Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.
Subject(s)
Humans , Male , Female , Arthroplasty, Replacement, Hip/methods , Acetabulum/surgery , Arthroplasty, Replacement, Hip/rehabilitation , Hip Injuries/diagnostic imaging , Hip Joint/diagnostic imagingABSTRACT
Introducción: Las convulsiones pueden producir una tensión muscular significativa capaz de fracturar el hueso. Se halló que el aumento significativo en la incidencia de fracturas se encuentra dentro del grupo de edad entre 45 a 64 años, lo que demuestra que los epilépticos no solo son más vulnerables a las fracturas, sino que tienen un comienzo de fractura más precoz. Las medidas de prevención comprenden suplementos de calcio, vitamina D, densitometría ósea y tratamiento con bifosfonatos, que deben reforzarse en pacientes con epilepsia que tienen riesgo de osteoporosis. Objetivo: Presentar casos de fracturas extracapsular e intracapsular de la cadera por convulsiones epilépticas, atendidos en el hospital Víctor Lazarte Echegaray, Trujillo, Perú, en el periodo comprendido entre 2013 y 2019. Presentación de los casos: Se reporta dos casos de fractura de cadera por convulsiones epilépticas, uno con fractura del acetábulo e iliaco izquierdo y otro a nivel del cuello femoral y subtrocantérica. Conclusiones: Las personas con convulsiones epilépticas poseen un mayor peligro de fracturas, por consiguiente se recomienda a los médicos que maximicen su conciencia sobre las fracturas relacionadas a convulsiones, en especial a pacientes con dolor postictal, debido a que los síntomas pueden ser inespecíficos y una mala interpretación puede impedir la rehabilitación(AU)
Introduction: Seizures can produce significant muscle tension capable of fracturing the bone. The significant increase in the incidence of fractures was found to be within the age group between 45 and 64 years, which shows that epileptics are not only more vulnerable to fractures, but also have earlier fracture onset. Prevention measures include calcium supplements, vitamin D, bone densitometry, and bisphosphonate treatment that should be reinforced in patients with epilepsy who are at risk for osteoporosis. Objective: To present cases of hip fractures due to epileptic seizures, treated at Víctor Lazarte Echegaray Hospital, Trujillo, Peru, from 2013 to 2019. Case report: Cases of hip fracture due to epileptic seizures have been reported, one with fracture of the acetabulum and left iliac and another at the level of the femoral and subtrochanteric neck. Conclusions: Individuals with epileptic seizures have greater risk of fractures, it is recommended that physicians maximize their awareness of seizure-related fractures, especially in patients with postictal pain, since the symptoms can be nonspecific and misinterpretation can prevent rehabilitation(AU)
Subject(s)
Humans , Adult , Middle Aged , Seizures/etiology , Hip Fractures/surgery , Hip Fractures/complications , Peru , Arthroplasty/methods , Acetabulum/surgeryABSTRACT
Since the concept of "safe area" put forward by Lewinnek, it has been widely recognized. While in recent years, many scholars have found that even if the acetabular prosthesis was placed on the "safe area", there were still many unexplained dislocation after total hip arthroplasty. And scholars began to question whether the "safe area" is really suitable for all patients. Spinal degeneration, deformity, lumbar fusion, etc. will lead to spine sagittal imbalance and changes in pelvic activity, which could lead to changes in acetabular orientation, and ultimately lead to edge loading, wear, impact, and even dislocation after total hip replacement. From the perspective of wear, impact and dislocation, it is determined by the functional positioning of the acetabular cup, not the anatomical positioning. The anatomical positioning and functional positioning of the neutral pelvic acetabular cup in the standing position can be considered equivalent. For pelvic rotation more than 20°, functional placement needs to be considered. In recent years, as the understanding of the internal relationship between the spine-pelvis-hip joint has become more and more profound, some scholars further classify the hip-spine relationship according to whether the spine is stiff or deformed, and propose corresponding acetabulums according to different types of hip-spine relationships The function of placement, so as to achieve a stable artificial hip joint. Therefore, it is of great significance to fully assess whether the patient's sagittal plane is balanced before surgery to guide artificial hip replacement surgery.
Subject(s)
Humans , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Joint , Hip Prosthesis , SpineABSTRACT
OBJECTIVE@#To measure the maximum corridor parameters of the infra acetabular screw and evaluate the feasibility of screw insertion through digital analysis of the acetabular structure.@*METHODS@#The pelvic CT data of 100 patients who received plain pelvic CT scan from April 2013 to June 2015 were retrospectively analyzed. There were 50 males, aged 20 to 84 years, with an average age of (48.42±17.48) years, and 50 females, aged 18 to 87 years, with an average age of (55.02±19.54) years. Patients with acetabular fractures, hip dysplasia, and metal implants in the acetabulum were excluded. Import CT data into Mimics software in DICOM format to generate a three-dimensional model, and find the axialprojection of the infra-acetabular corridor in the middle of the pubis ramus in the inlet view. A virtual screw was placed in the infra-acetabular space and measure the parameters including the diameter and the length of the maximum corridor, the distance from the insertion point to the pubic symphysis, to the anterosuperior iliac spine and to the medial edge of the pelvis. Then import the pelvic model into 3- matic software, establish the pelvic model anterior pelvic plane and median sagittal plane, and measure the angle between the screw axis and the two planes. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5 mm screw, and calculate the screw insertion rate.@*RESULTS@#In 100 cases, 49% of patients had a infra acetabular corridor with a diameter ≥5 mm, and the rate of screw placement in men was significantly higher than that in women. The average diameter of the maximum corridor of infra-acetabular screw was (4.86±1.72) mm, the average length was (94.04±8.29) mm, the average distance from the insertion point to the pubic symphysis was (60.92±4.84) mm, to the anterosuperior iliac spine was (85.15± 6.85) mm, and to the medial edge of the pelvis was (6.12±3.32) mm. The mean angle between the axis of the screw and the median sagittal plane was (-1.38±4.74)°, and the mean angle between the axis of the screw and the anterior pelvic plane was (56.77±7.93)°. There are significant differences between male and female measured parameters, except for the angle between the screw axis and the anterior pelvic plane. There was no statistically significant difference in the maximum corridor parameters of infra-acetabular screw on both sides of the pelvis.@*CONCLUSION@#This study shows that the insertion rate of infra-acetabular screws is low in local patients, and the feasibility of screw insertion should be fully evaluated before surgery.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Acetabulum/surgery , Bone Screws , Feasibility Studies , Fracture Fixation, Internal , Retrospective StudiesABSTRACT
OBJECTIVE@#To investigate the application value of liquid crystal digital display goniometer in total hip arthroplasty.@*METHODS@#From January 2018 to December 2019, 83 patients underwent primary total hip arthroplasty, including 28 males and 55 females, aged 42 to 81 (70.4±7.9) years. There were 63 cases of femoral neck fracture and 20 cases of avascular necrosis of femoral head. All patients used liquid crystal digital goniometer to control the anteversion of acetabular cup prosthesis during operation, and CT scanning was used to measure the anteversion of acetabular cup after operation. The two methods were compared to understand the accuracy of using liquid crystal digital goniometer.@*RESULTS@#Postoperative CT measurement showed that the acetabular anteversion of all patients was in the safe area advocated by Lewinnek. The anteversion angle of acetabular cup measured by liquid crystal digital goniometer was 14.20(12.80 to 15.40)°, and the anteversion angle of acetabular cup measured by postoperative CT scan was 14.20 (13.40 to 15.50)°. There was no significant difference between the two (@*CONCLUSION@#It is an accurate and reliable method to control the anteversion of acetabular cup with liquid crystal digital display angle instrument, which has a good auxiliary reference value.
Subject(s)
Female , Humans , Male , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Prosthesis , Liquid Crystals , Retrospective StudiesABSTRACT
To investigate the surgical effect of hip arthroscopic labrum reconstruction. A retrospective study was performed on the clinical data of 12 patients who underwent hip arthroscopic labrum reconstruction in our department from September 2017 to February 2021 and were followed up for 5-46 months, with an average of 21.5 months. All the patients had a hip joint space of more than 2 mm, and Tonnis grade less than level Ⅱ. These 12 patients underwent arthroscopic debridement of hyperplastic synovium, femoral head and neck and/or acetabular osteoplasty, and labrum reconstruction using autograft iliotibial band or gracilis tendon. After the surgery, we conducted follow-up and data collection, recorded the satisfaction of the patients and occurrence of complications, as well as the cartilage lesion of hip joint observed under the arthroscopy. We compared the alpha angle of Dunn X-ray film, center-edge angle (CE angle) of AP X-ray film, modified Harris hip score (mHHS score), hip outcome score (HOS), international hip outcome tool 12 score (iHOT12 Score), and visual analogue scale (VAS scale) before and after the arthroscopic operation, to assess clinical symptom relief and joint function recovery. The 12 patients were followed up for 5-46 (21.5±12.8) months. The VAS scale were (5.3±2.5) and (2.5±1.4) before and after the surgery, showing significant decrease (P=0.018). The mHHS score were (60.6±22.2) and (83.1±5.8) before and after the surgery, showing significant increase (P=0.003). The patient satisfaction was high (7.8±2.0) (range: 0-10). None of the 12 patients had serious complications, revision surgery, or total hip replacement at the end of the last follow-up. Autologous tendon transplantation for reconstruction of acetabular labrum under arthroscopy can improve the clinical symptoms and joint function of patients with femoroacetabular impingement (FAI), which is a safe and effective treatment.
Subject(s)
Humans , Acetabulum/surgery , Arthroscopy , Femoracetabular Impingement/surgery , Follow-Up Studies , Hip Joint/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Osteotomy/methods , Arthroscopy/methods , Hip Dislocation, Congenital/surgery , Acetabulum/surgery , Osteotomy/adverse effects , Follow-Up Studies , Treatment Outcome , Hip Dislocation, Congenital/diagnostic imagingABSTRACT
OBJETIVO: Evaluar los resultados radiológicos a corto y mediano plazo de pacientes operados de fractura de pared posterior de acetábulo, describir la morfología de la fractura, presencia de lesiones asociadas y la necesidad de artroplastia total de cadera (ATC) durante la evolución. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 40 pacientes operados entre julio de 2012 y julio de 2017 por fractura de pared posterior de acetábulo. Treinta y siete hombres y tres mujeres con una edad promedio de 41 años fueron operados (mediana de seguimiento 17,7 meses). Se registró el mecanismo del accidente y presencia de lesiones asociadas. Se registraron el número de fragmentos que presentaba la fractura, presencia de impactación marginal, compromiso de la cabeza femoral, presencia de fragmentos intra-articulares y complicaciones postoperatorias. Para el análisis estadístico se utilizó el test de Wilcoxon. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Un 70% de los pacientes presentó luxación posterior. La mayoría de los pacientes presentó una fractura entre 2 y 5 fragmentos (70%), 47,5% de los pacientes presentó impactación marginal, 37,5% compromiso de la cabeza femoral en zona de carga, 30% fragmentos intra-articulares. La complicación que más frecuente se observó fue la artrosis post-traumática la cual se presentó en un 22,5%. Cinco pacientes (12,5%) requirieron ATC. CONCLUSIÓN: Aunque se categorizan dentro de los patrones simples, las fracturas de pared posterior son lesiones complejas. La tomografía axial computada preoperatoria es esencial para determinar lesiones intra-articulares dada su alta frecuencia y también permite realizar un buen plan preoperatorio.
OBJECTIVE: Evaluate radiologic results in short and medium-term in surgically treated patients with acetabular posterior wall fracture. Describe fracture morphology, the presence of associated lesions and the necessity of total hip arthroplasty (THA) during the evolution. MATERIALS AND METHODS: A retrospective-descriptive study design of 40 patients treated during July 2012 and July 2017 for acetabular posterior wall fracture. 37 men and 3 women, 41 years old mean age. The mean follow-up was 17.7 months. Accident mechanism and presence of associated lesions were registered, as well as the number of fragments of the fracture, the presence of marginal impaction, femoral head compromise, intra-articular fragments and postoperatory complications. Wilcoxon test was used for the statistical analysis. RESULTS: Every case resulted due to a high energy accident. 70% of patients had posterior luxation of the hip. 70% of patients presented 2 to 5 fragments. 47.5% of patients presented marginal impaction, 37.5% compromised femoral head and 30% intra-articular fragments. The most frequent complication was post-traumatic arthrosis, which appeared in 22.5% of patients. Five patients required THA. CONCLUSION: Though it is categorized as simple fracture pattern, posterior wall fractures are complex. Preoperatory CT scan is essential to determine intra-articular lesions due to its high frequency and permits to plan an adequate intervention.
Subject(s)
Humans , Male , Female , Adult , Fractures, Bone/surgery , Fracture Fixation/methods , Acetabulum/injuries , Postoperative Complications , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Fractures, Bone/etiology , Fractures, Bone/diagnostic imaging , Fracture Fixation, Internal/methods , Acetabulum/surgery , Acetabulum/diagnostic imagingABSTRACT
Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.
Resumo Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4-5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2-3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2-3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0-12 horas; 3,14 entre 12-24 horas e 3,35 entre 24-48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.
Subject(s)
Humans , Male , Female , Pain, Postoperative/prevention & control , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Supine Position , Abdominal Muscles , Ultrasonography, Interventional , Acetabulum/surgery , Acetabulum/injuries , Acetaminophen/administration & dosage , Middle Aged , Nerve Block/adverse effectsABSTRACT
Resumen: Introducción: El abordaje anterior de cadera fue descrito en 1881, desde entonces se han realizado diversos estudios que han demostrado ventajas significativas frente a los abordajes posterior y lateral directo de cadera. Material y método: Se llevó a cabo un estudio descriptivo con casos continuos no probabilísticos en el Instituto de Ciencias Forenses de Octubre de 2015 a Julio de 2017. Se describió anatomía y distancias a los paquetes vasculonerviosos. Se realizó correlación de Pearson y Rho de Spearman. Resultados: Se efectuaron 22 disecciones, el nervio femorocutáneo fue identificado en nueve especímenes, la distancia promedio del nervio femorocutáneo lateral al intervalo de Smith-Petersen fue 11.4 mm, se identificó la arteria circunfleja lateral ascendente debajo del recto femoral hacia la región central del abordaje, se colocaron los separadores alrededor de la articulación coxofemoral sin lesionar estructuras vitales, el separador más riesgoso se ubicó en la pared anterior del acetábulo, debajo del músculo iliopsoas con distancia promedio de 28.25 mm al paquete femoral. A mayor edad mayor distancia a los paquetes neurovasculares p < 0.05. Conclusiones: Alto nivel de seguridad del abordaje anterior para artroplastía de cadera, las distancias a estructuras vitales presentan un margen razonable, en artroplastía de cadera ofrece adecuada exposición de la articulación, visión directa del acetábulo y disección quirúrgica atraumática.
Abstract: Introduction: The anterior hip approach was described since 1881, since then several studies have been conducted that have shown significant advantages over the posterior and lateral direct approaches of the hip. Material and method: We conducted a descriptive study with continuous non-probabilistic cases at the Institute of Forensic Sciences from October 2015 to July 2017. Anatomy and distances were described to the neurovascular bundles. Correlation of Spearman's Pearson and Rho was performed. Results: 22 dissections were made, the Femorocutaneous Nerve was identified in 9 specimens, the average lateral Femorocutaneous Nerve distance at Smith-Petersen interval was 11.4 mm, We identified the Ascending Lateral Circumflex artery under the femoral rectum towards the central region of the approach, the separators could be placed around the coxofemoral joint without injuring vital structures, the riskier separator we place it in the anterior wall of the acetabulum, below the Psoasyland with an average distance 28.25 mm to the femoral package. The older you go, the longer the neurovascular bundles were located p < 0.05. Conclusions: High level of safety of the previous approach for hip replacement, distances to vital structures have a reasonable margin, hip replacement offers adequate joint exposure, direct acetabulum vision and atraumatic surgical dissection.
Subject(s)
Arthroplasty, Replacement, Hip , Hip Joint/surgery , Femur , Acetabulum/surgeryABSTRACT
OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.
Subject(s)
Aged , Female , Humans , Male , Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Dislocation/surgery , Hip Joint , Hip Prosthesis , Kyphosis , Retrospective StudiesABSTRACT
Resumen: El quiste óseo aneurismático es una tumoración benigna poco común, de aparición en la infancia generalmente y a nivel de extremidades. El tratamiento más habitual consiste en el curetaje y relleno con injerto. No obstante, localizaciones poco accesibles a la cirugía suponen un reto terapéutico. Se presenta el caso de un paciente de 11 años con cojera y dolor en cadera derecha sin antecedente traumático ni infeccioso. En los estudios de imagen con TAC y RM se evidencia una lesión lítica expansiva que ocupa todo el techo del acetábulo y pala ilíaca derecha, sugestiva de un quiste óseo aneurismático presentando fractura acetabular asociada. Se realizó una biopsia que confirmó el diagnóstico. Se trató mediante embolización guiada por angiografía debido al gran volumen y alto riesgo de fractura, después del curetaje y relleno con aloinjerto evolucionó satisfactoriamente y el paciente se encuentra asintomático al año de la intervención.
Abstract: The aneurysmal bone cyst is a benign rare tumor, which usually develops during childhood and it's more often found in limbs. The most accepted treatment consists in curetagge and filling with graft. However, certain locations may be inaccesible for surgery and represent therapeutical challenges. We present the case of an 11 year-old male patient with limping and right hip pain without any traumatic nor infectious record. In the image studies with CT and MRI a lytic and expansive lession was found in the upper part of the right acetabulum and right iliac wing, all of which suggested an aneurysmal bone cyst with an associated acetabular fracture. A biopsy was performed which confirmed the diagnosis. He was treated with a CT-guided embolization and, due to its size, curetagge and allograft filling afterwards. He was asymptomatic after1 year of follow-up.