Refixation of the Excised Acetabular Labrum can Affect the Structural Changes of Cartilage Surface in the Hip Joint / La Refijación del Labrum Acetabular Extirpado Puede Afectar los Cambios Estructurales de la Superficie del Cartílago en la Articulación Coxal

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.

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study / Bloqueio do grupo de nervos pericapsulares do quadril com e sem auxílio de ultrassonografia: Estudo cadavérico comparativo

Abstract Objective To evaluate the technical reproducibility of a block of the pericapsular nerve group (PENG) of the hip aided or not by ultrasound in cadavers. Materials and Methods The present is a randomized, descriptive, and comparative anatomical study on 40 hips from 2 cadaver groups. We compared the PENG block technique with the method with no ultrasound guidance. After injecting a methylene blue dye, we verified the dispersion and topographical staining of the anterior hip capsule through dissection. In addition, we evaluated the injection orifice in both techniques. Results In the comparative analysis of the techniques, there were no puncture failures, damage to noble structures in the orifice path, or differences in the results. Only 1 hip from each group (5%) presented inadequate dye dispersion within the anterior capsule, and in 95% of the cases submitted to either technique, there was adequate dye dispersion at the target region. Conclusion Hip PENG block with no ultrasound guidance is feasible, safe, effective, and highly reliable compared to its conventional counterpart. The present is a pioneer study that can help patients with hip pain from various causes in need of relief.

Resumo Objetivo Propor e avaliar a reprodutibilidade técnica do bloqueio do grupo de nervos pericapsulares (pericapsular nerve group, PENG, em inglês) do quadril sem o auxílio da ultrassonografia, em cadáveres, de forma comparativa à realização do bloqueio guiado pela ultrassonografia em outro grupo de cadáveres. Materiais e Métodos Estudo anatômico randomizado, descritivo e comparativo, realizado em 40 quadris divididos em 2 grupos amostrais de cadáveres. Fez-se uma comparação da técnica do bloqueio do PENG à técnica não guiada por ultrassonografia injetando-se corante azul de metileno, seguida de dissecção para verificação da dispersão e da coloração topográfica da cápsula anterior do quadril, além de avaliação do pertuito das injeções entre as técnicas. Resultados Na análise comparativa das técnicas, não houve falha na punção, lesão de estruturas nobres no pertuito, ou diferença nos resultados. Não houve adequada dispersão do corante pela cápsula anterior somente em 1 quadril de cada grupo (5%), e em 95% dos casos submetidos a qualquer uma das técnicas observou-se dispersão adequada do corante pela região alvo. Conclusão O bloqueio do PENG do quadril sem auxílio de ultrassonografia é factível, seguro, eficaz, e com alta confiabilidade quando comparado à sua realização guiada pelo aparelho de imagem. Este estudo é pioneiro, e pode ajudar muito os pacientes que têm dor no quadril por diversas causas e necessitam alívio.

Does Acetabulum Remodel Following Varus Derotation Osteotomy for Perthes' Disease? / O acetábulo sofre remodelamento após a osteotomia derrotatória varizante em pacientes com doença de Perthes?

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.

Método simple para minimizar la discrepancia en la longitud de las extremidades y restaurar el offset en la artroplastia total de cadera / A Simple method to minimize limb length discrepancy and restore offset in total hip arthroplasty

Introducción: Existen más de 20 técnicas diferentes para corregir la discrepancia de miembros inferiores. El método que aquí se evalúa se basa en una clavija fija posicionada en el ala ilíaca asociada a un "calibre" móvil, con otra clavija con la que se marca la referencia en el trocánter mayor. Objetivo: Evaluar la confiabilidad de este dispositivo de medición usado durante la artroplastia total de cadera para restaurar la longitud del miembro inferior y el offset femoral. Materiales y Métodos: Se formaron dos grupos: grupo A con pacientes en quienes no se había usado el dispositivo y grupo B con pacientes en quienes sí se había usado el dispositivo. Se realizaron las mediciones en la radiografía panorámica de pelvis obtenida con el paciente de pie, antes de la cirugía y 3 meses después. Resultados: Se obtuvo una muestra de 80 pacientes (40 por grupo). Se logró corregir la discrepancia de la longitud de los miembros, pero no se hallaron diferencias estadísticamente significativas en la corrección promedio, entre ambos grupos (p = 0,07). Sin embargo, al analizar la varianza en la corrección de la discrepancia de la longitud de cada grupo se obtuvo una diferencia estadísticamente significativa (p <0,001). Conclusiones: Este dispositivo que permite una medición cuantificable más objetiva no asegura una corrección de la discrepancia de la longitud exacta a 0 mm, pero sí permite trabajar dentro de un rango más confiable y seguro. Nivel de Evidencia: III

Introduction: There are more than 20 different techniques to correct lower limb length discrepancy. The method evaluated in this study is based on a fixed pin in the iliac wing connected to a mobile gauge and another pin in the greater trochanter with which the reference is marked. The objective is to evaluate the reliability of this measurement device used during THA to restore lower limb length and femoral offset. Materials and Methods: Two groups were formed: Group A (patients who did not use the device) and Group B (patients who did use the device). Measurements were taken in the pre-surgery panoramic pelvic radiograph with the patient standing and three months later. Results: A sample of 80 patients was obtained, with 40 in each group. The difference in limb length could be corrected in each group, however the average correction achieved by both groups did not result in a statistically significant difference (p=0.07). However, when the variance in the correction of the difference in length of each group was examined, a statistically significant difference (p<0.001) was obtained. Conclusions: We can conclude that while this device, which serves as a more objective quantifiable measurement technique, does not guarantee a correction of the exact length discrepancy to 0 mm, it does allow us to work within a more dependable and safe range. Level of Evidence: III

Radiographic findings in the coxofemoral joint of Australian Cattle Dogs / Achados radiográficos em articulação coxofemoral de cães da raça Australian Cattle Dog

Australian Cattle Dogs (ACD) are medium-sized animals widely used in fieldwork for managing cattle and sheep. There needs to be more information about the conditions these dogs can develop despite being well-characterized animals since the beginning of the 20th century. Hip dysplasia (HD) is a developmental abnormality between the femoral head and the acetabular fossa, which can be debilitating. However, the available literature has no studies on the prevalence of this condition in dogs of this breed. This study aimed to evaluate radiographs of ACD qualitatively and quantitatively. For this purpose, 49 dogs considered healthy without clinical signs of HD were radiographically assessed, and the animals were classified as dysplastic (D) and non-dysplastic (ND). A frequency of 46.9% of dysplastic dogs was observed, with males being more affected. The cortical index (CI) and angle of inclination (AI) could not differentiate D from ND animals; only the Norberg angle (NA) was effective in this differentiation. No correlation was observed between AI, CI, and AN.(AU)

Os cães da raça Autralian Cattle Dog (ACD) são animais de porte médio, muito utilizados no trabalho de campo para manejo de gado e ovelha. Apesar de serem animais bem caracterizados desde o início do século XX, há poucas informações sobre afecções que esses cães podem desenvolver. A displasia coxofemoral (DCF) é uma anormalidade do desenvolvimento entre a cabeça do fêmur e a fossa acetabular podendo ser debilitante. Contudo, não há estudos, na literatura disponível, sobre a prevalência desta afecção em cães dessa raça. O objetivo deste trabalho foi avaliar qualitativamente e quantitativamente radiografias de cães da raça ACD. Para tanto, foram avaliados radiograficamente 49 cães considerados hígidos e sem sinais clínicos de DCF. Os animais foram classificados em displásicos (D) e não displásicos (ND). Observou-se a frequência de 46,9% de cães displásicos, sendo os machos mais acometidos. O índice cortical (IC) e o ângulo de inclinação (AI) não foram capazes de diferenciar os animais D dos ND, apenas o ângulo de Norberg (AN) foi eficaz nessa diferenciação. Não houve correlação entre AI, IC e AN.(AU)

Reconstrucción de labrum acetabular bilateral en hipoplasia labral con aloinjerto cadavérico / Bilateral acetabular labrum reconstruction in hypoplastic labrum with cadaveric allograft

El labrum acetabular es una estructura fibrocartilaginosa análoga a los meniscos, labrum glenoideo o fibrocartílago triangular. Cumple diferentes funciones biomecánicas como sellado articular, estabilidad articular, resistencia a la traslación, distribución de presiones, etc. En 2003 se describe que el pinzamiento femoroacetabular y la lesión labral son una de las causas de osteoartritis de la cadera. Existen múltiples clasificaciones para lesiones labrales, sin embargo, la de MAHORN incluye en su tipo II al labrum hipoplásico. La literatura define como labrum acetabular hipoplásico cuando el ancho es ≤5 mm, y puede ser de tipo primario (variante anatómica) o secundario (iatrogénica por desbridamiento previo). Existe un amplio espectro en el tratamiento de las lesiones labrales, que dependerá principalmente del tamaño del labrum, el patrón de la lesión, las características del tejido y la zona afectada; desde desbridamiento hasta reconstrucción labral con el fin de preservar la función biomecánica normal de la cadera y evitar el desarrollo de osteoartritis a largo plazo.A continuación, se describe el caso de un paciente de sexo masculino, de veintiocho años, con antecedente de pinzamiento femoroacetabular mixto bilateral y labrum acetabular hipoplásico bilateral, sometido a reconstrucción primaria de labrum derecho con aloinjerto cadavérico de peroneus longus e izquierdo con aloinjerto cadavérico de tendo Achillis, para el que se obtuvo un resultado clínico y funcional favorable. Nivel de Evidencia: IV

The acetabular labrum is a fibrocartilaginous structure analogous to the menisci, glenoid labrum, or triangular fibrocartilage. It fulfills different biomechanical functions, such as: joint sealing, joint stability, resistance to translation, pressure distribution, etc. In 2003 it was described that femoroacetabular impingement and labral injury is one of the causes of hip osteoarthritis. There are multiple classifications for labral lesions, however the MAHORN classification includes the hypoplastic labrum in its type II. The literature defines a hypoplastic acetabular labrum when its width is ≤5 mm, and it can be primary (anatomical variant) or secondary (iatrogenic due to previous debridement).There is a wide spectrum in the treatment of labral lesions, which mainly depends on the size of the labrum, the pattern of the lesion, the characteristics of the tissue and the affected area; from debridement to labral reconstruction in order to preserve the normal biomechanical function of the hip and avoid the development of osteoarthritis in the long term.The case of a 28-year-old male patient is described below, with a history of bilateral mixed-type femoroacetabular impingement and bilateral hypoplastic acetabular labrum, who underwent primary reconstruction of the right labrum with peroneus longus cadaveric allograft and left labrum with Achilles tendon cadaveric allograft, obtaining a favorable clinical and functional outcome. Level of Evidence: IV

Reducción incongruente de cadera tras luxación traumática por interposición de ceja posterior acetabular. Miniabordaje anterior de cadera y artroscopía seca para retiro del fragmento y evaluación articular / Posterior acetabular rim interposed within the joint after reduction of a traumatic hip dislocation. Anterior minimally invasive approach

Se presenta el caso de un paciente de veinte años a quien le queda un fragmento de la ceja acetabular posterior interpuesto dentro de la articulación tras la reducción de una luxación traumática de cadera. Se planteó un tratamiento por vía miniinvasiva anterior, con artroscopía seca con el fin de retirar el fragmento interpuesto, y la limpieza de la avulsión del ligamento redondo. En mesa de tracción se pudo retirar el fragmento interpuesto y evaluar el estado articular. Se muestran excelentes resultados clínicos e imagenológicos que desafían el concepto del abordaje posterior para lesiones posteriores. Nivel de Evidencia: III

The case of a twenty-year-old patient who has a fragment of the posterior acetabular rim interposed within the joint after reduction of a traumatic hip dislocation is presented. Anterior minimally invasive treatment was proposed, with dry arthroscopy to remove the interposed fragment and clean the round ligament avulsion. On the traction table, the interposed fragment could be removed, and the joint status evaluated. Excellent clinical and imaging results are shown what challenges the concept of a posterior approach for posterior lesions. Level of Evidence: III

Study on Influencing Factors of Artificial Hip Joint Test Quality Based on ISO/IEC 17025 and GLP / 中国医疗器械杂志

OBJECTIVE@#Taking artificial hip joint test as the object, integrating ISO/IEC 17025 and GLP, and establishing a new set of management requirements for test influence factors.@*METHODS@#The requirements of ISO/IEC 17025 and GLP regulations for influencing factors were compared and analyzed, the similarities and differences were found, and the two were integrated to formulate new management requirements for each influencing factor.@*RESULTS@#From the personnel, equipment, materials, methods, reports, filing and other factors, a set of management requirements in line with ISO/IEC 17025 and GLP was formulated, so that the laboratory can provide the objective, real and accurate test data for medical equipment manufacturers and regulatory authorities.@*CONCLUSIONS@#It can improve the test quality of the laboratory and ensure the authenticity and reliability of the test data and conclusions.

Progress in diagnosis and hip arthroscopic treatment of borderline developmental dysplasia of hip with Cam-type femoroacetabular impingement / 中国修复重建外科杂志

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.

A novel lateral classification of osteonecrosis of femoral head based on CT recons-truction of necrotic area and its clinical verification / 中国修复重建外科杂志

OBJECTIVE@#To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head (ONFH) in different Japanese Investigation Commitee (JIC) types, in order to summarize the prognostic rules of each type of ONFH, and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect.@*METHODS@#A total of 119 patients (155 hips) with ONFH between May 2004 and December 2016 were enrolled in the study. The total hips consisted of 34 hips in type A, 33 in type B, 57 in type C1, and 31 in type C2, respectively. There was no significant difference in age, gender, affected side, or type of ONFH of the patients with differenct JIC types ( P>0.05). The 1-, 2-, and 5-year femoral head collapse and operation of different JIC types were analyzed, as well as the survival rate (with femoral head collapse as the end point) of hip joint between different JIC types, hormonal/non-hormonal ONFH, asymptomatic and symptomatic (pain duration >6 months or ≤6 months), and combined preserved angle (CPA) ≥118.725° and CPA<118.725°. JIC types with significant differences in subgroup surgery and collapse and with research value were selected. According to the location of the necrotic area on the surface of the femoral head, the JIC classification was divided into 5 subtypes in the lateral CT reconstruction, and the contour line of the necrotic area was extracted and matched to the standard femoral head model, and the necrosis of the five subtypes was presented by thermography. The 1-, 2-, and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed, and the survival rates (with collapse of the femoral head as the end point) between CPA≥118.725° and CPA<118.725° hip in patients with this subtype were compared, as well as the survival rates of different lateral subtypes (with collapse and surgery as the end points, respectively).@*RESULTS@#The femoral head collapse rate and operation rate in the 1-, 2-, and 5-year were significantly higher in patients with JIC C2 type than in patients with other hip types ( P<0.05), while in patients with JIC C1 type than in patients with JIC types A and B ( P<0.05). The survival rate of patients with different JIC types was significantly different ( P<0.05), and the survival rate of patients with JIC types A, B, C1, and C2 decreased gradually. The survival rate of asymptomatic hip was significantly higher than that of symptomatic hip, and the survival rate of CPA≥118.725° was significantly higher than that of CPA<118.725° ( P<0.05). The lateral CT reconstruction of type C1 hip necrosis area was selected for further classification, including type 1 in 12 hips, type 2 in 20 hips, type 3 in 9 hips, type 4 in 9 hips, and type 5 in 7 hips. There were significant differences in the femoral head collapse rate and the operation rate among the subtypes after 5 years of follow-up ( P<0.05). The collapse rate and operation rate of types 4 and 5 were 0; the collapse rate and operation rate of type 3 were the highest; the collapse rate of type 2 was high, but the operation rate was lower than that of type 3; the collapse rate of type 1 was high, but the operation rate was 0. In JIC type C1 patients, the survival rate of the hip joint with CPA≥118.725° was significantly higher than that with CPA<118.725° ( P<0.05). In the follow-up with femoral head collapse as the end point, the survival rates of types 4 and 5 were all 100%, while the survival rates of types 1, 2, and 3 were all 0, and the difference was significant ( P<0.05). The survival rate of types 1, 4, and 5 was 100%, of type 3 was 0, and of type 2 was 60%, showing significant difference ( P<0.05).@*CONCLUSION@#JIC types A and B can be treated by non-surgical treatment, while type C2 can be treated by surgical treatment with hip preservation. Type C1 was classified into 5 subtypes by CT lateral classification, type 3 has the highest risk of femoral head collapse, types 4 and 5 have low risk of femoral head collapse and operation, type 1 has high femoral head collapse rate but low risk of operation; type 2 has high collapse rate, but the operation rate is close to the average of JIC type C1, which still needs to be further studied.

Patients Who Present with Functional Limitations, Limited Range of Motion and Reduced Muscle Strength 6 Months after Total Hip Arthroplasty: A Cross-Sectional Study / Pacientes que apresentam limitações funcionais, amplitude de movimento limitada e força muscular reduzida, 6 meses após a artroplastia total do quadril: Um estudo de corte transversal

Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b

Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.

Anthropometric Tomographic Study of the Hip in a Brazilian Regional Population / Estudo antropométrico tomográfico do quadril em uma população regional brasileira

Abstract Objective The present study aimed to determine the average hip anthropometry of a regional Brazilian population using measurements based on computerized axial tomography (CAT). Methods Retrospective, descriptive analysis of hip measurements from 200 abdominal CATs from patients visiting a medical center. The tests were selected at random to determine 30 previously defined anthropometric measurements. The data were statistically analyzed and compared according to gender and age. Results The prevalence of hip dysplasia was 6%. Signs suggesting femoroacetabular impingement were seen in 26% of cases. Patients over 50 years old presented significantly greater measures of horizontal acetabulum sectors, center-edge angle, and acetabular arch, as well as lower extrusion index, cervical-diaphyseal angle and vertical offset. Some measurements were significantly different according to gender: the lateral center-edge angle (µ » 35.5°) and the acetabular arch (µ » 68.7°) were higher in females. Males presented increased extrusion index (µ » 16%), lateral offset (µ » 38.3 mm), depth (µ » 19.5 mm), and neck diameter (µ » 26.4 mm). Conclusion The present study characterized the hip anthropometry of a regional Brazilian population. It also demonstrated significant morphological differences per age group and gender.

Resumo Objetivo Determinar a antropometria média do quadril de uma população regional brasileira através de medidas obtidas pela tomografia axial computadorizada (TAC). Método Análise analítico-descritiva, retrospectiva, de medidas coxofemorais de 200 TACs do abdômen de pacientes atendidos em um centro médico. Foram selecionados aleatoriamente exames que permitissem a aferição de 30 medidas antropométricas previamente definidas. Os dados foram estatisticamente analisados e comparados quanto a sexo e idade. Resultados A prevalência de displasia do quadril foi de 6%. Sinais sugestivos de impacto fêmoro-acetabular foramvistosem26% doscasos.A análise dos resultadosnogrupoacima de 50 anos demonstrou medidas significativamente maiores dos: setores horizontais do acetábulo,doângulocentro-bordaedoarcoacetabular,acompanhadosdemenoríndicede extrusão, ângulo cérvico-diafisário e offset vertical. Algumas medidas foram significativamente diferentes em função do sexo: o ângulo centro-borda lateral (µ» 35.5°) e o arco acetabular(µ» 68.7°)semostraram maioresnosexo feminino.Nogrupomasculino,foram maiores o índice de extrusão (µ» 16%), o offset lateral (µ» 38,3mm), a profundidade (µ» 19,5mm) e o diâmetro do colo (µ» 26,4mm). Conclusão O presente estudo caracterizou a antropometria do quadril de uma população brasileira. Demonstrou ainda diferenças morfológicas significativas do quadril entre diferentes faixas etárias e sexos.

Artroplastía total de cadera primaria con vástagos cortos en pacientes menores de 20 años / Primary total hip arthroplasty with short stems in patients under 20 years old

Introducción: El objetivo de este estudio fue analizar los resultados clínicos, radiográficos y funcionales en pacientes <20 años sometidos a artroplastia total de cadera con vástago femoral tipo 2B corto no cementado. Materiales y Métodos: Se realizó un estudio retrospectivo de 13 pacientes (16 artroplastias totales de cadera) operados entre enero de 2006 y enero de 2021. La edad media y el índice de masa corporal eran de 16.5 ± 2.5 años y 22,74 ± 4,06 kg/m2, respectivamente. El seguimiento medio fue de 43.3 meses (rango 12-128, DE ± 33.45). Se analizaron las indicaciones quirúrgicas, y los resultados funcionales y radiográficos. La supervivencia del implante se calculó con la estimación de Kaplan-Meier. Resultados: La indicación predominante fue necrosis avascular (9/16 caderas [56%]), el 66% estaba asociada al uso prolongado de corticoides. El HHS para cadera mejoró significativamente de 33 ± 16,5 a 94 ± 5,6 (p <0,001). Diez (76%) pacientes usaban dispositivos de asistencia para caminar antes de la artroplastia, pero ninguno los necesitaba al final del seguimiento. Se observó radiolucidez en un componente acetabular sin repercusión clínica hasta el final del seguimiento. No se registraron signos radiográficos de aflojamiento del componente femoral. La supervivencia del implante fue del 100% hasta el final del seguimiento. Conclusiones: La artroplastia total de cadera primaria con un vástago femoral corto no cementado en pacientes <20 años con artrosis avanzada de cadera logró resultados equiparables a los ya publicados, con la particularidad de que es un procedimiento menos invasivo y ahorra capital óseo femoral. Nivel de Evidencia: IV

Introduction: To our knowledge, there is no published literature on the outcomes of short-stem total hip arthroplasty (THA) in patients under 20 years old. This study aimed to analyze clinical, radiological, and functional outcomes in patients under 20 years of age undergoing THA with a short uncemented 2B femoral stem. Materials and Methods: We carried out a retrospective study of 13 patients (16 THAs) treated between January 2006 and January 2021. The mean age and BMI were 16.5±2.5 years and 22.74±4.06 kg/m2, respectively. The mean follow-up was 43.3 months (range 12-128, SD ± 33.45). Surgical indications, as well as functional and radiologic outcomes, were analyzed. Implant survival was calculated with the Kaplan-Meier estimate. Results: The predominant indication was avascular necrosis (9/16 hips [56%]), of which 66% were associated with prolonged use of cor-ticosteroids. Eight (50%) of the cases had undergone surgeries before the THA. The Harris hip score improved significantly from 33±16.5 to 94±5.6 (p<0.001). Ten (76%) patients required assistive devices to walk preoperatively, and no patient required them at the end of follow-up. Radiolucency was evident in one acetabular component, without clinical implications. There were no signs of femoral component loosening. The implant survival was 100% at the last follow-up. Conclusions: Short stems in primary THAs in patients under 20 years of age with advanced hip osteoarthritis showed clinical, functional, and radiological outcomes comparable to those previously reported in the literature for conventional stems, with the particularity of being less invasive and sparing femoral bone stock. Level of Evidence: IV

Secuenciación de próxima generación para la detección de patógenos en cirugía de cadera: experiencia y viabilidad diagnóstica en un centro de atención terciaria de la Argentina / Next generation sequencing for the detection of pathogens in hip surgery. Experience and diagnostic feasibility in a tertiary care center in Argentina

Introducción: El diagnóstico rápido y definitivo con identificación del patógeno es fundamental cuando hay una infección periprotésica. La secuenciación de próxima generación permite identificar el ADN en un germen determinado en poco tiempo. Hasta donde sabemos, no hay reportes sobre su empleo para el manejo de la infección periprotésica en Sudamérica. Nuestro objetivo fue demostrar la viabilidad diagnóstica de las muestras obtenidas de una serie de pacientes operados en Buenos Aires, Argentina, y analizadas con la técnica de secuenciación de próxima generación. materiales y métodos: Se analizó a una serie prospectiva de 20 pacientes sometidos a cirugía de revisión séptica y aséptica de cadera desde diciembre de 2019 hasta marzo de 2020. Se obtuvieron muestras intraoperatorias de líquido sinovial, tejido profundo y canal endomedular, que fueron enviadas para su análisis al laboratorio NexGen Microgen. Resultados: Se seleccionaron 17 pacientes, porque tenían una muestra apta para analizar. Los resultados se recibieron dentro de las 72 h de la cirugía. En un caso, el resultado de la secuenciación de próxima generación informó un germen distinto del identificado en los cultivos posoperatorios de partes blandas, esto permitió corregir la antibioticoterapia. En otro, esta técnica identificó Parabacteroides gordonii en una revisión aséptica, en otro, Morganella morganii, a partir de cultivos negativos en una revisión en un tiempo. Conclusión: Se demostró la viabilidad diagnóstica con la secuenciación de próxima generación, se pueden obtener resultados de microorganismos patógenos dentro de las 72 h posteriores a la cirugía en pacientes con infección periprotésica y cultivos negativos. Nivel de Evidencia: IV

Introduction: Early diagnosis of a periprosthetic joint infection (PJI) and identification of the pathogen are paramount. Next-generation sequencing (NGS) can identify the nucleic acids in a given germ in a short period. To our knowledge, there are no reports of its use in the management of PJI in South America. Our objective was to demonstrate the diagnostic feasibility of the NGS technique on the samples obtained from a series of patients operated on in Buenos Aires, Argentina. Materials and methods: A prospective series of 20 patients undergoing septic and aseptic hip revision surgery from December 2019 to March 2020 was analyzed. Intraoperative samples of synovial fluid, deep tissue, and intramedullary canal were obtained and sent to the NexGen Microgen laboratory (Texas, USA) for analysis. Results: Seventeen patients were finally eligible to present a sample suitable for analysis. In 100% of the samples, NGS results were obtained within 72 hours of surgery. In one case, the NGS result reported a germ different from the one identified in the postoperative soft tissue cultures, allowing antibiotic therapy to be corrected. In another case, NGS identified Parabacteroides gordonii in aseptic revision surgery. In another patient, the NGS identified Morganella morganii, in which conventional postoperative cultures were negative in single-stage revision surgery. Conclusion: In this study, we demonstrated the diagnostic feasibility of NGS, obtaining results within 72 hours immediately after surgery for pathogenic organisms in patients with PJI and negative cultures. Level of Evidence: IV

Análisis clínico y radiográfico del vástago de cadera no cementado "CEMENTFREE"® de fabricación nacional. Resultados a corto plazo / Clinical and radiographic analysis of the CemenTFRee® uncemented hip stem of national manufacture. Short-term results

Introducción: La estabilidad del componente femoral y su resistencia al hundimiento son factores críticos para lograr una correcta osteointegración y el éxito clínico de la artroplastia total de cadera no cementada. Hay pocos estudios que evalúen los resultados con vástagos de fabricación nacional, aun los de corto y mediano plazo. El objetivo de este estudio fue realizar un análisis clínico y radiográfico de pacientes sometidos a un reemplazo total de cadera con implante de un componente femoral de fabricación nacional (CEMENTFREE®). Materiales y métodos: Se llevó a cabo un estudio retrospectivo con pacientes sometidos a un reemplazo total de cadera con vástago CEMENTFREE®, entre enero de 2015 y agosto de 2020, a cargo del mismo cirujano y en la misma institución. Resultados: Se implantaron 46 vástagos sin cementación en 42 pacientes (rango etario: 60-81 años). El seguimiento promedio fue de 3 años (mín. 1 año, máx. 5 años). Aplicando el Harris Hip Score se observó una franca mejoría (promedio 47 en el preoperatorio y 93 después de la cirugía). La tasa de supervivencia fue del 100% a los 5 años. Conclusión: La artroplastia de cadera con el vástago CEMENTFREE® de fabricación nacional ha demostrado ser una opción comparable con otros vástagos importados, en cuanto a los resultados clínicos y radiográficos a corto plazo. Resta evaluar los resultados a mediano y largo plazo. Nivel de Evidencia: IV

Introduction: The stability of the femoral component and its resistance to subsidence are critical factors to achieve correct osseointegration and subsequent clinical success in cementless total hip arthroplasty. Few studies have evaluated the results of nationally manufactured stems, even in the short and medium term. Our objective is to clinically and radiologically analyze patients undergoing a total hip replacement with a nationally manufactured femoral component (Cementfree® stem).materials and methods: We carried out a retrospective study on patients who had undergone a total hip replacement with the Cementfree® stem between January 2015 and August 2020 by the same surgeon and at the same institution.Results: 46 uncemented stems were implanted in 42 patients with an age range between 60 and 81 years. The average follow-up was 3 years, with a minimum of 1 year and a maximum of 5 years. There was an evident improvement in the Harris Hip Score (an average of 47 preoperatively vs. 93 after surgery). The revision of the stem for aseptic loosening, in the Kaplan Meier analysis, demonstrated a 100% survival rate at 5 years. Conclusion: According to the results obtained in this research, hip arthroplasty with the nationally manufactured Cementfree® stem has proven to be an option comparable to other imported stems in terms of short-term clinical and radiographic outcomes. An evaluation of the outcomes in the medium and long term is pending. Level of Evidence: IV

Sinovitis transitoria de cadera en un niño como probable manifestación inicial atípica de COVID-19 / Transient synovitis of the hip in a pediatric patient as an atypical initial manifestation of COVID-19

Comunicamos el caso de un niño con sinovitis de cadera como manifestación inicial atípica de una infección por SARS-CoV-2. Varón de 7 años que consultó por dificultad en la marcha e impotencia funcional con dolor localizado en la cadera derecha. El diagnóstico presuntivo fue sinovitis transitoria de cadera, por lo que recibió tratamiento conservador. A los 12 días, continuaba con impotencia funcional y presentó decaimiento y fiebre. Ante la evolución atípica del cuadro, se decidió su internación para punción articular/drenaje. Se obtuvo un líquido articular claro de aspecto inflamatorio que no presentó desarrollo en los cultivos bacterianos. Durante la internación, se confirmó el resultado positivo de la reacción en cadena de la polimerasa para SARS-CoV-2. El paciente evolucionó favorablemente una vez resuelto el cuadro viral. En el último seguimiento, no tenía síntomas y el rango de movilidad era completo. La sinovitis transitoria de cadera puede ser una manifestación clínica inicial atípica de COVID-19. En el contexto de la pandemia, es indispensable sospechar una posible artropatía reactiva como consecuencia del virus, principalmente cuando la presentación es atípica, hay contactos familiares estrechos, fiebre u otros síntomas respiratorios asociados. Nivel de Evidencia: IV

We report the case of a pediatric patient with transient synovitis of the hip as an initial atypical manifestation of a COVID-19 infection. A 7-year-old boy presented with gait disturbance, limping, and pain in his right hip. After 12 days, the patient continued with functional limitations and had associated symptoms such as fatigue and fever. Because of the atypical course, he was admitted to the hospital for joint aspiration. Due to institutional protocols, the preoperative evaluation included a COVID-19 PCR test. The joint aspiration sample showed clear synovial fluid with inflammatory characteristics and negative bacterial culture. COVID-19 PCR test results came out positive during the patient's hospital stay. Clinical symptoms improved after the viral condition resolved. In the last follow-up, he was asymptomatic with a full hip range of motion. Transient synovitis of the hip could be an atypical initial symptom of a COVID-19 infection. Given the pandemic context of this disease, it is important to consider reactive arthritis as a consequence of this infection, especially in cases of atypical presentation, close family contact, fever, or other associated respiratory symptoms. Level of Evidence: IV

Extracción de proyectil acetabular por artroscopía de cadera / Acetabular bullet removal for hip arthroscopy

La extracción artroscópica de un proyectil articular de cadera por herida de bala se introdujo por primera vez por Cory y cols. en 1998. El misil puede ubicarse flotando libremente dentro de la articulación, ubicado cercano a esta o alojado dentro del hueso del acetábulo o de la cabeza femoral. Se presenta el caso de un paciente de treinta y dos años, quien fue asaltado. El proyectil se alojaba en el trasfondo del acetábulo luego de un trayecto abdominal.La artroscopía de cadera es un procedimiento mínimamente invasivo que resultó efectivo para el retiro de un proyectil articular, resultando menos cruento que una artrotomía. No se encontraron complicaciones. Nivel de Evidencia: III

Arthroscopic removal of a bullet from the hip joint was introduced first by Cory et al. in 1998. The missile can be located freely floating within the joint, located close to the joint, or lodged within the acetabulum bone or the femoral head. A case is presented in a thirty-two-year-old patient, who was assaulted. The projectile lodged in the background of acetabula fossa after an abdominal trajectory.Hip arthroscopy is a minimally invasive procedure that was effective for the removal of a joint projectile resulting in less morbidity than an arthrotomy. No complications were found. Level of Evidence: III