Clinical study on core decompression in treating osteonecrosis of the femoral head of the necrotic bone-in different site / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of decompression and bone grafting on osteonecrosis of the femoral head(ONFH) at different sites of necrotic lesions.@*METHODS@#A total of 105 patients with ARCOⅡstage ONFH admitted from January 2017 to December 2018 were retrospectively analyzed. There were 71 males and 34 females, with an average age of (55.20±10.98) years old. The mean course of all patients was(15.91±9.85) months. According to Japanese Inveatigation Committee (JIC) classification, all patients were divided into 4 types:17 cases of type A, 26 cases of type B, 33 cases of type C1 and 29 cases of type C2. All four groups were treated with decompression of the pulp core and bone grafting. Visual analogue scale(VAS) and Harris hip joint score were used before and at 3, 6, 12, and 24 months after the operation, and the collapse of the femoral head was observed by X-ray examination within 2 years.@*RESULTS@#All 105 patients were successful on operation without complications, and the mean follow-up duration was (24.45±2.75) months. Harris score showed that there was no statistical difference among four groups before surgery and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in intragroup Harris scores at preoperative and postoperative time points among four groups (P<0.01). VAS showed that there was no statistical difference among four groups before and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in VAS at preoperative and postoperative time points among four groups (P<0.01). None of the patients in four groups had femoral head collapse before and 3, 6 months after surgery. At 12 months after operation, there were 3 cases of femoral head collapse in group C and 4 cases in group C2(P>0.05);At 24 months after operation, 1 case of femoral head collapse occurred in group B, 6 cases in group C1 and 8 cases in group C2(P<0.05).@*CONCLUSION@#Core decompression and bone grafting can improve the effect of ONFH and hip preservation. The effect of hip preservation for ONFH is closely related to the location of the osteonecrosis lesion, so the influence of the location of lesion on the effect of hip preservation should be considered in clinical treatment, so as to make better preoperative hip preservation plan.

What is the role of core decompression in the early stages of osteonecrosis of the femoral head? Evaluation of the surgical result by functional score and radiological follow-up / Qual o papel da descompressão simples em estágios precoces na osteonecrose da cabeça femoral? Avaliação do resultado cirúrgico por meio de escore funcional e acompanhamento radiológico

ABSTRACT Objectives: This study is aimed at evaluating whether core decompression of the femoral head in the early stages of femoral head osteonecrosis improves patients' subjective perception of pain and avoids the progression of the disease to a femoral head collapse and a final indication of total hip arthroplasty. Methods: Eighteen patients (30 hips) in the early stages of the disease (Ficat and Arlet 1 and 2A) were evaluated through clinical, radiological, risk factor maintenance, and by the functional Merle D'Aubigné, and Postel score before and after core decompression of the femoral head. Results: There was an improvement of symptoms up to the sixth month in 83.3% of the hips evaluated through the Merle D'Aubigné and Postel score. However, 73.3% of the cases evolved with femoral head collapse, and in 50%, total hip arthroplasty was indicated regardless of whether or not the risk factors were maintained. Conclusions: Core decompression of the femoral head improves patients' pain early in the initial stages of the pathology. However, it does not alter the prognosis and the ultimate indication of total hip arthroplasty in the final stages of the disease.

RESUMO Objetivos: O presente estudo tem como objetivo avaliar se a descompressão simples da cabeça femoral nos estágios iniciais da osteonecrose da cabeça femoral melhora a percepção subjetiva da dor dos pacientes e se evita a progressão da doença para o colapso da cabeça femoral e a indicação final de artroplastia total do quadril. Métodos: Foram avaliados 18 pacientes (30 quadris) em estágios iniciais da doença (Ficat e Arlet 1 e 2 A) por critérios clínicos, radiológicos, manutenção dos fatores de risco e pela escala funcional de Merle D'Aubigné e Postel antes e após a descompressão simples da cabeça femoral. Resultados: Houve melhoria dos sintomas precocemente (até o sexto mês) em 83,3% dos quadris avaliados pela escala de Merle D'Aubigné e Postel. No entanto, 73,3% dos casos evoluíram com colapso da cabeça femoral e em 50% deles foi indicada artroplastia total do quadril, independentemente da manutenção ou não dos fatores de risco. Conclusões: A descompressão simples da cabeça femoral melhora a dor dos pacientes precocemente nos estágios iniciais da patologia. Entretanto, não altera o prognóstico da doença e a indicação final de artroplastia total do quadril nos estágios finais da doença.

Implante de células mononucleares en la osteonecrosis de cabeza femoral / Implant of mononuclear cells in femoral head osteonecrosis

La necrosis aséptica de la cabeza femoral (NACF) es la muerte de tejido óseo en la cabeza del fémur debido a inadecuado riego sanguíneo, la misma se ha asociado a diversas causas. En la osteonecrosis el grado de destrucción tanto de la arquitectura ósea como de la red de aporte sanguíneo a la cabeza del fémur se afecta en extremo y en muchos casos es necesaria la cirugía como las osteotomías valguizantes, varizantes, Sugioka y otras). En este estudio se utilizó la descompresión central asociada a la terapia celular. Se presenta un paciente masculino de 46 años, con antecedentes de Diabetes Mellitus, bebedor habitual, al cual se le diagnosticó de NACF de cadera izquierda mediante tomografía computarizada, y posteriormente se le realizó cirugía con perforaciones por vía lateral trocantérica (Descompresión Central) y administración de células mononucleares autólogas. El paciente fue dado de alta a las 48 h de operado, con limitación del apoyo los primeros 10 días, y después deambulación asistida. Se le realizaron radiografías a los 6 meses del implante. Después de un año de operado se le da alta y se indica la reincorporación del paciente a sus actividades sociales habituales, no constatando progresión de la osteonecrosis, y logrando así la deambulación sin asistencia(AU)

Aseptic necrosis of the femoral head (AVN-FH) is the death of bone tissue in the femoral head because of inadequate blood supply; it has been associated with various causes. The degree of destruction of bone architecture and the blood supply network to the femoral head is extremely affected. In many cases, surgery is necessary as valgus osteotomies, varus, Sugioka and others. Core decompression associated with cell therapy was used in this study. A male patient aged 46 is presented here. this patient has history of Diabetes Mellitus, regular alcohol consumption, he was diagnosed with aseptic necrosis of the femoral head left hip with CT scan, and he subsequently underwent surgery by perforated lateral approach trochanteric (Central Decompression) and administration of autologous mononuclear cells. The patient was discharged 48 hours after surgery, with limited support during the first 10 days, and then assisted ambulation. Radiographs were performed at 6 months after implantation. After a year of surgery the patient is discharged and he is instructed to return to his usual social activities, noting no progression of osteonecrosis, thus, non-assisted ambulation is achieved(AU)

Fifteen-year Results of Precoated Femoral Stem in Primary Hybrid Total Hip Arthroplasty

BACKGROUND: There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties. METHODS: On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases. RESULTS: Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1). CONCLUSIONS: An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.

Stem cell implantation for osteonecrosis of the femoral head

What is the most effective treatment for the early stages of osteonecrosis of the femoral head? We assessed multiple drilling and stem cell implantation to treat the early stages of osteonecrosis of the femoral head. We report the clinical and radiological results of stem cell implantation and core decompression. In total, 128 patients (190 hips) who had undergone surgery were divided into two groups based on which treatment they had received: (1) multiple drilling and stem cell implantation or (2) core decompression, curettage and a bone graft. The clinical and radiographic results of the two groups were compared. At 5-year follow-up, in the stem cell implantation group, 64.3% (27/42) of the patients with Stage IIa disease, 56.7% (21/37) of the patients with Stage IIb disease and 42.9% (21/49) of the patients with Stage III disease had undergone no additional surgery. In the conventional core decompression group, 64.3% (9/14) of the patients with Stage IIa disease, 55.6% (5/9) of the patients with Stage IIb disease and 37.5% (3/8) of the patients with Stage III disease had undergone no additional surgery. Success rates were higher in patients with Ficat Stage I or II lesions than in those with Stage III lesions. There were no statistically significant differences between the groups in terms of success rate or in the clinical and radiographic results of the two methods. Essentially the same results were found with stem cell implantation as with the conventional method of core decompression.

Avascular necrosis of bone in children with leukemia

A vascular necrosis of the bone [AVNB] is an uncommon serious complication of acute leukemia. Between the years 1997-2007, seven children with acute leukemia of different risk groups presented with symptoms, signs and investigational evidence of avascular necrosis of bone. They were all diagnosed during their maintenance chemotherapy except one patient who had AVNB post-transplant following hematological relapse. Six patients had avascular necrosis of the hip [AVNH], and one patient had avascular necrosis of the foot. Other complications for steroids, such as hyperglycemia were observed in some of the patients. The steroids were omitted in almost all patients immediately. Two patients had surgical intervention and the rest received conservative management. Two patients recovered fully and the rest are still under follow-up at orthopedic clinic pending further management

[Core decompression in stage 1 idiopathic necrosis of the femoral head]

The osteonecrosis of the femoral head is a progressive multi-etiologieal disease; its prim urn inoveizs is circulatory and the pathophysiology is still unexplained. Ficat and Arlet classified this disease into 5 stages from 0 to IV. The progression from one stage to another is inevitable if surgical treatment is not performed early. The MRI is currently the investigation of choice in detecting infraradiological stage I necrosis. The core decompression as proposed by Ficat and Arlet allows to excise the necrotic zone, confirm the histological diagnosis, decompress the intramedullary increased pressure and favor the ncovascularization of the femoral head. The aim of this study is to present the mid-term results of the core decompression in a series of 17 hips in 16 patients with an average age of 46 years that were operated upon in stage I idiopathic necrosis of the femoral head, 4 to 6 weeks after the symptoms appeared. The MRI demonstrated the zone of necrosis iii 16 hips. The histological examination confirmed the diagnosis of necrosis in 16 hips including the one which was negative on MRI. The Merle d'Aubigne hip score was used for the clinical evaluation and showed to be less than 15 in all hips preoperatively. This score improved to 18 [full value] after a mean follow-up of 8 years, ranging from 3 to 13 years. The X-rays of the operated hips remained normal at the final follow-up in all cases. The very high percentage [100%] of recovery and healing in stage I femoral head necrosis hi this series may be explained by the absence of obvious etiological factors [idiopathic necrosis] and moreover by the short delay between the onset of the symptoms and the operative treatment. We believe that the MRI is the examination of choice that should be done early hi patients with a painful hip and normal X-rays and that core decompression performed soon is an excellent procedure to treat stage I idiopathic necrosis of the femoral head

Artroplastia excisional pelo acesso dorsal-caudal em 16 cães com necrose asséptica na cabeça do fêmur / The excisional arthroplasty through the dorsocaudal access of 16 dogs with aseptic necrosis of the femoral head / Arthoplastía escisional por acceso dorso-caudalen 16 perros con necrosis aséptica de la cabeza femoral

O trabalho teve como objetivo, descrever a técnica da artroplastia excisional pelo acesso dorso-caudal em 16 cães com necrose asséptica da cabeça do fêmur, como uma nova alternativa terapêutica cirúrgica para o alívio do paciente traumatizado. A necrose asséptica da cabeça femoral, também conhecida como Legg-Calvé-Perthes, apresenta em todos os casos, o osso da cabeça e colo femorais com necrose e deformação. Acomete normalmente animais de pequeno porte, apresentando ao exame clínico claudicação gradual do membro afetado, devido à dor articular. Ao exame radiográfico observam-se focos de diminuição da densidade óssea na cabeça e colo femorais, e em casos mais graves presença de osteófitos na margem acetabular dorsal. Foram atendidos 16 cães (7 Poodle; 4 Pinscher; 1 Pequinês; 1 Beagle; 1 Yorkshire Terrier; 2 Sem Raça Definida) no Hospital Veterinário da Universidade Norte do Paraná (UNOPAR), Arapongas, PR, com diagnóstico de necrose asséptica da cabeça do fêmur. O tratamento preconizado foi cirúrgico, através da artroplastia por excisão da cabeça e colo femorais com abordagem dorso-caudal, e o pós-operatório constituíram-se de antibioticoterapia por 3 dias, curativo tópico até a cicatrização da ferida cirúrgica. A administração de DMSO (Dimesol®) na dose de 0,8 mL/Kg diluído em 125 mL de solução fisiológica de NaCl a 0,9%, durante 4 dias, repouso nos primeiros 7 dias e volta gradativa ao exercício. O retorno ao uso do membro afetado e o desaparecimento total da claudicação foram observados 20 dias após a cirurgia.

The aim of this study is to describe the excisional arthroplasty technique through dorsocaudal access in 16 dogs with aseptic necrosis of the femoral head as a new therapeutic alternative for the relief of traumatized patients. The femoral head necrosis, also known as Legg-Calvé-Perthes, presents, in all cases, both the bone of the femoral head and the neck with necrosis and deformation. Small animals are usually affected thus presenting a gradual level of lameness upon the painful member due to joint pain in the clinical exam. Traits of bone density loss in the femoral head and neck, and, in severe cases, the occurrence of osteophyte in the dorsal border of acetabular appear in the radiographical exam. Sixteen dogs (7 Poodle; 4 Pinscher; 1 Pekinese; 1 Beagle; 1 Yorkshire Terrier; 2 mongrel dogs) presenting aseptic necrosis of the femoral head were assisted in the Veterinary Hospital of the Universidade do Norte do Paraná (UNOPAR) in Arapongas–PR . The surgery was carried out through the excision arthroplasty of the head and femoral neck with a dorsocaudal approach. The postoperative period consisted of antibioticotherapy for 3 days, topical curative until the surgical wound healing. The administration of 0,8 ml/kg DMSO (Dimesol®) diluted into 125 ml of NaCL 0.9% physiological solution for 4 days; a rest cure in the first 7 days followed by a gradual return to the exercise. Returning to use the affected member as well as the total disappearance of the lameness level was observed 20 days after the surgery.

El trabajo tuvo como objetivo, describir la técnica de la artroplastía por escisión dorsal en 16 perros con necrosis aséptica de la cabeza femoral como una nueva alternativa terapéutica de la cirugía para el alivio del paciente traumatizado. La necrosis aséptica de la cabeza femoral, también conocida como Legg-Calvé-Perthes, presenta en todos los casos, el hueso de la cabeza y cuello femoral con necrosis y deformaciones. Acomete normalmente a los animales de pequeño porte, presentando en el examen clínico claudicación gradual del miembro afectado, debido al dolor articular. En el examen radiográfico se observa focos de disminución de la densidad ósea en la cabeza y en el cuello femoral, y en los casos más graves, la presencia de osteófitos en la borda del acetábulo dorsal. Fueron atendidos 16 perros [7 Poodles, 4 pinscher, 1 pequinés, 1 Beagle, 1 Yorkshire Terrier, 2 Sin Raza Definida (SRD)] en el Hospital Veterinario de la Universidad Norte del Paraná (UNOPAR) - Arapongas-PR con diagnóstico de necrosis aséptica de la cabeza femoral. El tratamiento proconizado fue la cirugía a através de la artroplastía por escisión de la cabeza y el cuello femoral con abordaje dorso-caudal y el posoperatorio se constituyó de antibiótico terapia por 3 (tres) días, curativo tópico hasta la cicatrización de la herida quirúrgica, administración de DMSO (Dimesol®) en la dosis de 0,8 ml/kg diluído en 125 ml de solución fisiológica de NaCL a 0.9% por 4 (cuatro) días, reposo en los primeros 7 (siete) días y vuelta gradual a los ejercicios. El retorno al uso del miembro afectado y el desaparecimiento total de la claudicación fue observado 20 (veinte) días después de la cirugía.

Clasificación y diagnóstico de la osteonecrosis de cabeza femoral / Classification and diagnosis of the femoral head osteonecrosis

Se realizó una revisión bibliográfica de actualización sobre el controvertido tema de la osteonecrosis de cabeza femoral para profundizar en el uso de las clasificaciones tanto cualitativas como cuantitativas de la afección y enfatizar en su importancia diagnóstica y terapéutica. Se abordó la utilidad de la resonancia magnética nuclear y la gammagrafía ósea en el diagnóstico y control evolutivo del paciente. Se describe la afección acetabular propuesta por diferentes autores

A Case of Avascular Necrosis of the Femoral Head as Initial Presentation of Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) is a malignant clonal disorder of hemopoietic stem cells characterized by abnormal proliferation and accumulation of immature granulocyte. Leukostasis is one of the complications of CML and is characterized by partial or total occlusion of microcirculation by aggregation of leukemic cells and thrombi leading to respiratory, ophthalmic or neurologic symptoms. We experienced a rare case of avascular necrosis of the femoral head as the initial presentation of chronic myelogenous leukemia. A 24-year-old male patient was admitted to our hospital with pain in the right hip joint. The patient was diagnosed to be suffering from chronic myelogenous leukemia by packed marrow with granulocytic and megakaryocytic hyperplasia and the presence of Philadelphia chromosome. The right hip joint pain was attributed to avascular necrosis of the femoral head. And the avascular necrosis could be considered as the complication of chronic myelogenous leukemia due to microcirculatory obstruction of the femoral head. The avascular necrosis of the right femoral head was treated with bipolar hemiarthoplasty.

Síndrome de edema de la médula ósea de cadera / Bone marrow edema syndrome of the hip

Background: Bone marrow edema syndrome (BMES) is a rare clinical condition. Its etiology is unknown and it can be seen in different locations. In the case of the hip, avascular necrosis is the main differential diagnosis. Aim: To present our experience of BMES of the hip and a review of the literature. Patients and methods: Retrospective analysis of clinical records of patients with hip pain that met clinical, radiological, and magnetic resonance imaging criteria for BMES. Clinical outcome and clinical and radiological follow up are presented. Results: Two men and two women (one of them pregnant) aged 42, 48, 36 and 26 years old, fulfilled criteria. Treatment included limited weight bearing, non steroidal antiinflammatory drugs, intranasal calcitonin and physical therapy. Complete remission of symptoms was observed within five to seven months. At an average follow up of 36 months, all patients presented complete function of the hip, returning to their previous activity levels, with no new episodes of BMES. Conclusions: It is important to be aware of this condition as part of the differential diagnosis of hip pain to avoid aggressive and unnecessary diagnostic and therapeutic procedures (Rev Méd Chile 2004; 132: 947-54).

Enfermedad de Perthes: revisión bibliográfica / Perthes' disease: bibliographic review

La enfermedad de Perthes es una patologia osteoarticular que afecta a la población infantil, sus secelas alteran el desarrollo dela cabeza del fémur y la relación de ésta cone l acetábulo será anormal, lo que predispone a una degeneración del cartílago articular, dando como resultado una artrosis prematura; por lo tanto los ovimientos del abducción, educción y rotación de la cadera estarán restringidos, produceindo una limitación funcional con claudicación en la march que, en mucos casos, acarrea trastornos psicológicos en losniños. Eisten diferentes tipos de tratamiento ortopédicos y quirúrgicos, que en ningún caso restauran completamente la anatomía y la función de la articulación de la cadera. Esto conduce a realizar una revisión de todos los tratamientos ortopédicos y quirúrgicos que se efectuán. Así miso, se revisa las nuevas propuestas etiológicas, los exámenes complemtarios y el pronóstico a que éstos conducen. El proposito de este estudio es que los especialistas que tratan a niños con enfermedad de Perthes conozcan todas las opciones que existen en la actualidad para tratar esta enfermedad, a fin de disminuir las secuelas y las consecencias que conlleva.

Osteonecrosis aséptica de la cabeza del fémur: desde la clínica / Femur head aseptic osteonecrosis: clinical view

La osteonecrosis aséptica de cabeza de fémur es una enfermedad de etiología multifactorial y tratamiento multidisciplinario. Presentamos nuestra casuística, enfatizando en los aspectos clínicos y etiopatogénicos. Consideramos que el médico generalista desempeña un rol trascendente en el diagnóstico precoz de esta enfermedad.

Uso do laser arseneto de gálio (904nm) após excisão artroplástica da cabeça do fêmur em cães / Use of gallium arsenide laser (904nm) after arthroplasty excision of the femoral head in dogs

OBJETIVO: Avaliar a ação do laser diodo Arseneto de Gálio na evolução pós-operatória de cães submetidos à excisão artroplástica da cabeça e colo do fêmur. MÉTODOS: Treze cães portadores de Legg-Calvé-Perthes Disease ou Necrose Asséptica da Cabeça do Fêmur (NACF) foram divididos em dois grupos: (I) sete cães que não foram irradiados - grupo controle; (II) seis cães irradiados uma vez ao dia durante cinco dias consecutivos com o laser Arseneto de Gálio (904nm), densidade de energia 4J/cm2 e tempo de exposição automaticamente ajustado pelo aparelho. Para a avaliação da evolução pós-operatória preencheu-se protocolo com graduação da dor de apoio do membro operado. Utilizou-se teste estatístico não paraméRESULTADOS: O grupo I iniciou o apoio do membro com uma média de 12 dias de pós-operatório e o grupo II com uma média de quatro dias de pós-operatório, sendo estatisticamente significante (p=0.0012). trico U de Mann-Whitney para análise dos resultados. CONCLUSÃO: A irradiação com o laser de baixa potência Arseneto de Gálio (904nm) na dose 4J/cm2, periarticular, promoveu rápido retorno da função do membro em cães após a excisão artroplástica da cabeça do fêmur, otimizando a recuperação pós-operatória.

Chronic myeloid leukemia presenting with avascular necrosis of femur head.

We report the case of a 15 years girl in whom avascular necrosis (AVN) of right femur head was the presenting feature of chronic stable phase of chronic myeloid leukemia (CML). To date, only three case of CML with AVN have been reported. So, in view of rarity of this condition, a similar case of CML presenting as AVN of femur head is being reported.

Osteonecrosis del cóndilo femoral: informe de 32 casos / Osteonechrosis of femoral condyle: report of 32 cases

Se revisaron 32 casos de osteonecrosis idiopática espontánea del cóndilo femoral medial en 29 pacientes, 18 mujeres y 11 hombres, con una edad entre 60 y 73 años, tratados entre 1986 y 1992 con un seguimiento medio de 85 meses, presentándose a consulta entre uno y 36 meses (media cuatro meses) después del inicio de los síntomas. En el primer examen se tuvieron siete casos en el estadio I de Koshino, ocho casos en el estadio II, 11 en el estadio III y seis en el estadio IV. Cinco casos del estadio I pasaron al estadio II dentro de los tres meses después de la primera observación, mientras que en los otros dos los cóndilos se aplastaron y desarrollaron un modelo artrósico moderado del compartimiento interno en los cinco años sucesivos. De estos cinco casos y los ocho casos del estadio II del inicio, nueve casos evolucionaron hacia un estadio III dentro del año siguiente, con una degradación artrósica con el tiempo en todos los casos. En el estadio IV se presentó un deterioro artrósico y un aumento del varo de la rodilla. Los siete casos del estadio I y cuatro casos del estadio II (15 por ciento) con lesiones de menos de 3.5 cm2, se trataron inicialmente en forma no quirúrgica evolucionando satisfactoriamente. En los tres casos del estadio II de superficie entre 3.5 cm2 y 5 cm2 tratados por artroscopia y perforaciones, se fracasó en dos casos, mientras que el tercer caso continúa en estadio II. Una osteotomía tibial valgizante de descarga se practicó en 20 rodillas en el estadio III, seis se relacionaron con injerto osteocondral autólogo fresco, siete (35 por ciento) presentaron un resultado aceptable. El agregar el injerto no mejoró el resultado. En 19 casos (60 por ciento) se realizó la colocación de prótesis total de la rodilla como tratamiento definitivo. Estos resultados y sus porcentajes son hechos comparables de la indicación de las prótesis en el tratamiento de las artrosis de rodilla.

A etiologia na osteonecrose da cabeça femoral / Etiology of the femoral head osteonecrosis

O objetivo deste trabalho é analisar o desenvolvimento do conhecimento sobre a etiologia da osteonecrose da cabeça femoral e suas implicaçoes clínicas. Baseado em 91 quadris tratados com descompressao e enxerto ósseo em 77 pacientes, procura-se estabelecer uma associaçao entre esse tratamento e a citologia dos casos. Sao estudados os fatores prognósticos e os achados sao submetidos a análise estatística e confrontados com a leteratura. Os resultados do tratamento sao satisfatórios em 74,7 por cento dos casos e a citologia nao é considerada como fator prognóstico significante.

RM de la necrosis avascular no traumática de cadera / Avascular necrosis of the coxofemoral joint: MR finding

El objetivo de este trabajo es determinar los hallazgos más frecuentes de necrosis avascular de cadera encontrados en RM, la relación entre patrones de distribución de la grasa medular y esta patología y el papel de la RM en su diagnóstico precoz. A tal efecto realizamos un estudio retrospectivo de los 82 estudios de cadera y pelvis ósea realizados en nuestro Centro entre julio de 1995 y julio de 1997, de las cuales 60 fueron solicitadas como RM de cadera y 22 como RM de pelvis. Del total, 21 fueron diagnosticadas como necrosis avascular y 4 con diferente distribución del patrón graso medular. De ellos, según la clasificación de Beltrán y de Mitchell, 19 caderas estaban en estadio temprano y 2 en estadio avanzado. A todos estos pacientes se les había solicitado estudio de cadera a excepción de una que pertenecía al grupo de pelvis ósea

Fatores prognóstico no tratamento da osteonecrose da cabeça femoral / Prognosis factors in the treatment of osteonecrotic femoral heads

Este estudo foi feito a partir de 91 quadris em 77 pacientes portadores de osteonecrose nao traumática da cabeça femoral. O tratamento consistiu na descompressäo e enxerto ilíaco, sendo os resultados avaliados clinicamente pelo Método de Merle D'Aubigné-Postel. Os possíveis fatores prognósticos foram analisados estatisticamente em relaçäo aos seguintes parâmetros: estagiamento, idade, sexo, etnia, etiologia e bilateralidade. As associaçöes significantes foram encontradas em relaçäo ao estagiamento e idade, que foram considerados fatores prognósticos.