Short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis.@*METHODS@#The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE TM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared.@*RESULTS@#All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( P<0.05); but there was no significant difference in plantarflexion range of motion ( P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( P>0.05); there was a significant difference in the difference of other radiographic parameters ( P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( P>0.05).@*CONCLUSION@#TAA using the INBONE TM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.

Osteonecrosis múltiple inducida por glucocorticoides / Multiple osteonecrosis induced bye glucocorticoids / Osteonecrose múltipla induzida por glicocorticóides

La osteonecrosis múltiple es una entidad poco frecuente que se define por el compromiso de al menos tres regiones diferentes. Es indispensable el abordaje multidisciplinario de los pacientes que la padecen tanto para el diagnóstico como el tratamiento oportuno. Presentamos el caso clínico de un paciente joven que presenta una osteonecrosis múltiple con compromiso de ambas caderas, hombros, rodillas, codo derecho y cuello de pie izquierdo. El principal factor de riesgo presente en nuestro caso es el consumo de glucocorticoides.

Multiple osteonecrosis is a rare entity that is defined by the involvement of at least three different regions. A multidisciplinary approach to patients who suffer from it is essential for both diagnosis and timely treatment. We present the clinical case of a young patient who presented multiple osteonecrosis with involvement of both hips, shoulders, knees, right elbow, and neck of the left foot. The main risk factor present in our case is the consumption of glucocorticoids.

A osteonecrose múltipla é uma entidade rara que se define pelo envolvimento de pelo menos três regiões diferentes. Uma abordagem multidisciplinar aos pacientes que sofrem com isso é essencial para o diagnóstico e tratamento oportuno. Apresentamos o caso clínico de um paciente jovem que apresenta osteonecrose múltipla envolvendo quadris, ombros, joelhos, cotovelo direito e pescoço do pé esquerdo. O principal fator de risco presente no nosso caso é o consumo de glicocorticóides.

Lubricación in vitro en prótesis articulares / In Vitro Lubrication In Joint Prostheses

Entender el desgaste prematuro en reemplazos articulares debido a una lubricación deficiente, que puede resultar en valores de fricción altos, es un tema amplio e intrincado de abordar. Además, si el lubricante es el fluido sinovial, los mecanismos de lubricación que ocurren son aún más complejos de develar. En este artículo se revisa el estado de conocimiento actual de la lubricación sinovial, así como las características reológicas del fluido lubricante. Asimismo, se mencionan algunas técnicas experimentales y métodos numéricos con los que se ha estudiado el problema de la lubricación. En algunas simulaciones numéricas de la lubricación en reemplazos articulares no se considera el efecto del esfuerzo cortante del líquido sinovial ya que se asume que tiene un comportamiento newtoniano, sin embargo, otras investigaciones han demostrado que al asumir un comportamiento no newtoniano el proceso de lubricación se afecta significativamente. Con todo esto, incorporar todos los factores que pueden afectar la lubricación en reemplazos articulares, en simulaciones numéricas hasta la fecha es un reto. A través de diversas investigaciones se buscan nuevos materiales, diseños y técnicas de análisis que permitan incrementar la vida útil de los implantes para así reducir las cirugías de revisión(AU)

derstanding premature wear in joint replacements due to poor lubrication, which can result in high friction values, is a broad and intricate topic to address. In addition, if the lubricant is the synovial fluid, the lubrication mechanisms that occur are even more complex to unveil. This article reviews the current state of knowledge on synovial lubrication, as well as the rheological characteristics of the lubricating fluid. It is also made a mention of some experimental techniques and numerical methods with which the problem of lubrication has been studied. In some numerical simulations of lubrication in joint replacements the effect of the shear stress of the synovial fluid is not considered since it is assumed to have a Newtonian behavior; however, other research has shown that by assuming a non-Newtonian behavior the lubrication process is significantly affected. With all this, incorporating all the factors that can affect lubrication in joint replacements, in numerical simulations to date is a challenge. Through various investigations, new materials, designs and analysis techniques are sought to increase the useful life of implants in order to reduce revision surgeries(AU)

Caracterización de pacientes con fractura de cadera, intervenidos con artroplastia / Characterizing Patients with Hip Fracture, Operated with Arthroplasty

Introducción: Las lesiones traumáticas de la cadera ocupan uno de los propósitos más importantes de la cirugía traumatológica. El uso de la artroplastia como regla de oro en el tratamiento quirúrgico de las mismas, es el fundamento del trabajo. Objetivo: Caracterizar los pacientes con diagnóstico de fractura de cadera, intervenidos con artroplastia total y parcial y estudiar la mortalidad, según el tipo de prótesis utilizada. Métodos: Se realizó un estudio descriptivo de corte transversal retrospectivo en 1506 pacientes del Hospital Ortopédico Docente Fructuoso Rodríguez entre 2015 y 2019, portadores de fractura de cadera, y tratados con artroplastia. Se analizaron variables tales como edad, sexo y comorbilidades presentes. Resultados: Se colocaron prótesis totales a 427 pacientes y en 1079 se utilizó la modalidad de prótesis parcial. Predominaron las personas entre 61 y 80 años de edad. El sexo femenino prevaleció en el estudio, con una relación 3:1. Predominó el grupo de pacientes con 1 o 2 enfermedades asociadas. La mortalidad < 30 días resultó el 1,1 por ciento y ≥ 30 días el 9,2 por ciento. Conclusiones: La utilización de prótesis totales dista mucho de la media interpuesta actualmente en el mundo, donde la prótesis total se maneja como herramienta de elección. Las prótesis parciales quedan reservadas para pacientes que tienen una corta expectativa de vida y muy poco validismo(AU)

Introduction: Traumatic hip injuries occupy one of the most important purposes of trauma surgery. The use of arthroplasty as a golden rule in their surgical treatment is the foundation of the work. Objectives: To characterize patients with a diagnosis of hip fracture, who underwent total and partial arthroplasty and to study mortality, according to the type of prosthesis used. Methods: A descriptive retrospective cross-sectional study was carried out in 1506 patients from Fructuoso Rodríguez Orthopedic Teaching Hospital from 2015 to 2019, with hip fracture, and treated with arthroplasty. Variables such as age, sex, and present comorbidities were analyzed. Results: Total prostheses were placed in 427 patients and in 1079 the partial prosthesis modality was used. Persons between 61 and 80 years of age predominated. The female sex prevailed in this study, with a 3: 1 ratio. The group of patients with 1 or 2 associated diseases predominated. Mortality <30 days was 1.1 percent and ≥30 days was 9.2 percent. Conclusions: The use of total prostheses is far from the current average in the world, where the total prosthesis is used as the tool of choice. Partial prostheses are reserved for patients who have short life expectancy and very little validity(AU)

Componentes protésicos más usados en la artroplastia total de cadera en las provincias centrales / Most Used Prosthetic Components in Total Hip Arthroplasty in Central Provinces

Introducción: La cirugía de la artroplastia y el recambio de una prótesis de cadera es una cirugía compleja y costosa. La estrategia quirúrgica y componentes protésicos son completamente diferentes en función de las deformidades óseas existentes y características anatómicas personales de cada paciente, por tanto, la planificación de suministros de los diferentes componentes es básica para cubrir las demandas de la población necesitada y la adecuada eficiencia económica para evitar gastos innecesarios por sobreestimación o infraestimación de las demandas. Objetivos: Determinar las necesidades por medidas de los diferentes tipos de componentes protésicos utilizados en la artroplastia total de cadera en las provincias centrales y de este modo optimizar las inversiones, con las ventajas económicas que supone. Métodos: Estudio longitudinal descriptivo retrospectivo de los casos operados de artroplastia total de cadera en el Hospital Arnaldo Milián Castro de Villa Clara, desde diciembre de 1998 hasta la fecha. Se analizan las variables edad, sexo, procedencia y componentes protésicos. Se recoge la información en la base de datos creada en SPSS, donde se realizan los análisis estadísticos. Resultados: La edad media fue 62,36 años. El grupo de 61 - 80 años fue el de mayor incidencia con 215 pacientes. Predominó el sexo masculino 51,8 por ciento. La mayor incidencia, correspondió a Villa Clara con 692 pacientes. Los componentes cementados 46 - 50 fueron los más usados y en los no cementados los más usados fueron 48-56. Vástagos Tipo Müller 7.5 - 12.5. RALCA Cementadas T0-T4, no cementados T1-T3. En las SLA, 11.5 y 13. Los cuellos estándar fueron los de mayor incidencia con 390 pacientes. Conclusiones: Con las incidencias de las diferentes medidas utilizadas por cada uno de los componentes expresados, se puede determinar con bastante exactitud la demanda de cada medida por cada 100 casos pendientes de operación. Esto permite satisfacer las demandas de las medidas más usadas y hacer una distribución apropiada a la hora del suministro, lo que redundaría en un beneficio económico vital en las actuales condiciones del país(AU)

Introduction: The arthroplasty surgery and the replacement of a hip replacement is a complex and expensive surgery. The surgical strategy and prosthetic components are completely different depending on the existing bone deformities and personal anatomical characteristics of each patient, therefore, the planning of supplies of the different components is essential to meet the demands of the needy population and adequate economic efficiency to avoid unnecessary expenses due to overestimation or underestimation of claims. Objective: To determine the needs by measurements of the different types of prosthetic components used in total hip arthroplasty in the central provinces and thus optimize investments, with the economic advantages that it entails. Methods: A retrospective descriptive longitudinal study was carried out of the total hip arthroplasty operated cases at Arnaldo Milián Castro Hospital in Villa Clara, from December 1998 to date. Age, sex, origin and prosthetic components are the variables examined. The information is collected in the database created in SPSS, statistical analyzes was performed. Results: The mean age was 62.36 years. The group of 61-80 years was the one with the highest incidence (215 patients). Male sex predominated (51.8 percent). The highest incidence corresponded to Villa Clara (692 patients). The cemented components 46-50 were the most used and in the uncemented components the most used were 48-56. Müller Stems 7.5 - 12.5. RALCA Cemented T0-T4, uncemented T1-T3. In the SLA the most used were 11.5 and 13 respectively. Standard necks were those with the highest incidence (390 patients). Conclusions: The demand for each measure can be determined quite accurately for every 100 cases pending operation with the incidents of the different measures used by each of the components expressed, allowing to meet the demands of the most used measures and appropriate distribution at supplying, which would result in vital economic benefit in the current conditions of the country(AU)

Evaluation of therapeutic efficacy of arthroplasty with Swanson prosthesis in the surgical treatment of 2-5 metatarsophalangeal joint diseases / 北京大学学报(医学版)

OBJECTIVE@#Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint.@*METHODS@#From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery.@*RESULTS@#The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%.@*CONCLUSIONS@#With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.

Osteochondroma of mandibular ramus and condylar neck: simultaneous resection and reconstruccion with personalized alloplastic joint prosthesis / Osteocondroma de la rama mandibular y cuello del cóndilo: resección y reconstrucción simultánea con prótesis articular personalizada aloplástica

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Los osteocondromas son tumores osteogénicos benignos que pueden alcanzar grandes tamaños, los cuales requieren de resección quirúrgica y generalmente de algún tratamiento adicional para restaurar la forma y la función mandibular. En este caso, un osteocondroma localizado en la rama mandibular y el cuello del cóndilo fue reseccionado y reconstruido simultáneamente a través de un reemplazo articular total. Después de la cirugía, el paciente permanece asintomático y recupera los intervalos de apertura y cierre, la fonación y la función masticatoria. La reconstrucción inmediata después de la resección es una buena alternativa para evitar una segunda operación, y la planificación virtual prequirúrgica garantiza la eliminación completa de la lesión utilizando guías de corte y cubriendo todo el defecto con una prótesis articular aloplástica personalizada.

Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review

ABSTRACT Backgroud: Daptomycin has been used in bone and joint infections (BJI) and prosthesis joint infections (PJI) considering spectrum of activity and biofilm penetration. However, the current experience is based on case reports, case series, cohorts, and international surveys. The aim of this systematic review was to evaluate studies about daptomycin treatment efficacy in BJI/PJI compared to other antibiotic regimens. Methods: PubMed, LILACS, Scielo and Web of Science databases were searched for articles about daptomycin and treatment of BJI and PJI from inception to March 2018. Inclusion criteria were any published researches that included patients with BJI treated with daptomycin. Diagnosis of BJI was based on clinical, laboratory and radiological findings according to IDSA guidelines. Results: From 5107 articles, 12 articles were included. Only three studies described the outcomes of patients with BJI treated with daptomycin with comparator regimen (vancomycin, teicoplanin and oxacillin). Studies presented large heterogeneity regarding device related infections, surgical procedures, and daptomycin regimens (varied from 4 mg/kg to 10 mg/kg). A total of 299 patients have been included in all studies (184 infections associated with orthopedic disposal and 115 osteomyelitis/septic arthritis). Two hundred and thirty-three patients were treated with daptomycin. The clinical cure rates on device related and non-device related infections (i.e. osteomyelitis) were 70% and 78%, respectively. Compared to all regimens evaluated, daptomycin group outcomes were non-inferior. Conclusion: Although a randomized clinical trial is needed, this systematic review tends to support daptomycin usage for bone and joint infections.

Complicaciones a mediano plazo de la prótesis monopolar modular de cabeza radial / Mid-term complications of the monopolar, modular radial head prosthesis

Resumen: Introducción: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. Material y métodos: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). Resultados: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head) . La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. Discusión: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. Conclusión: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.

Abstract: Introduction: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. Material and methods: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). Results: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. Discussion: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. Conclusion: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.

Management of Periprosthetic Joint Infection / 대한고관절학회지

Periprosthetic joint infection (PJI) is a serious complication after arthroplasty, which is associated with pain, prolonged hospital stay, multiple surgeries, functional incapacitation, and even mortality. Using scientific and efficient management protocol including modern diagnosis and treatment of PJI and eradication of infection is possible in a high percentage of affected patients. In this article, we review the current knowledge in epidemiology, classification, pathogenesis, diagnosis and treatment of PJI.

Biomateriais utilizados na artroplastia parcial ou total da articulação temporomandibular: uma revisão de literatura / Biomaterials used in partial or total temporomandibular joint arthroplasty: a review of the literature

Introdução: as disfunções da articulação temporomandibular constituem uma variedade de doenças que compreendem disfunções nos músculos da mastigação, nas estruturas articulares ou em ambos. Em alguns casos a melhora da disfunção pode decorrer apenas de tratamento clínico conservador, porém, quando os resultados não são favoráveis, o tratamento cirúrgico deve ser considerado. A reconstrução articular parcial ou total é uma das formas de tratamento cirúrgico disponível. Objetivo: objetivo deste trabalho foi realizar uma revisão bibliográfica sobre os principais biomateriais disponíveis para a reconstrução da articulação temporomandibular. Método: o trabalho foi realizado na base de dados da Pubmed, Scielo e Periódicos Capes. Os descritores empregados foram: artoplastia temporomandibular, prótese articular, disfunção temporomandibular. As referências foram avaliadas quanto à relevância correlacionadas ao tema proposto. Foram selecionados os artigos em português e inglês, publicados no período de Janeiro 1971 a outubro de 2017. Considerações finais: existe a recomendação de haver uma continuidade de esforços para melhorar o material aloplástico para que os resultados obtidos com essa técnica se tornem o tratamento padrão para a DTM severa, contudo é importante não se esquecer de esgotar as modalidades terapêuticas conservadoras antes de se prosseguir para qualquer tipo de cirurgia. Nos casos onde uma prótese articular total é indicada, que os princípios biomecânicos sejam respeitados e que estudos clínicos metodologicamente adequados sejam realizados para fundamentarem esta condição de maneira referendada para a substituição aloplástica da ATM.

Introduction: temporomandibular joint dysfunctions are a variety of diseases that include dysfunctions in masticatory muscles, joint structures, or both. In some cases the improvement of the dysfunction may only result from conservative clinical treatment, however, when the results are not favorable the surgical treatment should be considered. Partial or total joint reconstruction is one of the forms of surgical treatment available. Objective: the objective of this work was to perform a bibliographic review on the main biomaterials available for the reconstruction of the temporomandibular joint. Method: work was carried out in the database of Pubmed, Scielo and Capes Periodicals. The descriptors employed were: temporomandibular arthroplasty, joint prosthesis, temporomandibular dysfunction. The references were evaluated regarding the relevance correlated to the proposed theme. The articles in Portuguese and English, published between January 1971 and October 2017, were selected. Final remarks: there is a recommendation for continuity of efforts to improve the alloplastic material so that the results obtained with this technique become the treatment standard for severe TMD, but it is important to remember to exhaust the conservative therapeutic modalities before proceeding for any type of surgery. In cases where a total joint prosthesis is indicated, biomechanical principles are respected and methodologically adequate clinical studies are performed to support this condition in a manner recommended for the alloplastic replacement of TMJ.

Qualite de vie des amputés trans-femoraux à Cotonou

L'amputation d'un membre pelvien compromet l'une des grandes fonctions motrices de l'homme qu'est la marche. Et plus le niveau d'amputation est proximal, plus importantes sont les difficultés fonctionnelles. Objectif : Etudier la qualité de vie des amputés trans-fémoraux, appareillés à Cotonou. Méthode : Etude transversale à visée descriptive et analytique, ayant consisté à revoir en Janvier et Février 2013, les amputés trans-fémoraux suivis et appareillés au CNHU-HKM de Cotonou, de 2003 à 2012, soit 10 ans plus tôt. Après examen clinique du moignon et de la prothèse, la qualité de vie de ces patients a été évaluée grâce au Medical Outcome Study Short Form 36 (MOS SF36). Résultats : Les patients ont été surtout des hommes (76%), âgés de 12 à 77 ans avec une moyenne de 40,56 ans. Leur revenu mensuel moyen a été de 61000F CFA. L'amputation a été surtout à gauche (70%), complication de traumatisme (78%), de diabète (10%) ou d'infection (10%). La prothèse leur a été confectionnée depuis 35,54 mois en moyenne et 88% en ont été satisfaits. La qualité de vie des sujets a été excellente (30%), très bonne (66%). Elle a été influencée par l'âge des patients. Conclusion : La qualité de vie des amputés trans-fémoraux de notre étude apparaît encourageante pour la plupart des patients. Cela semble discordant au vu du bas niveau de développement économique de notre pays qui devrait influencer la qualité de l'appareillage. La solidarité africaine n'a-t-elle pas aussi eu une part importante dans le déterminisme de la qualité de vie de ces patients ?

Hardware System for the Test of Artificial Joint Biomechanics / 中国医疗器械杂志

In the research of artificial joint biomechanics, it is a common method in the world to evaluate the biomechanical properties of the implanted fixtures through experiments . The domestic research started late, and the corresponding testing methods were lacking. There is still no unified standard. In this paper, a complete hardware test system was designed and built around the existing mechanical testing machine, including:binocular vision catcher, torque bearing clamp, film pressure sensor and so on. The system can accurately measure the relative motion angle value, external torque value, and inter pressure value of each joint. It has some reference significance for the forming and standardization of the artificial joints' evaluation system.

Infections after shoulder arthroplasty are correlated with higher anesthetic risk score: a case-control study in Brazil

ABSTRACT Purposes: Shoulder arthroplasty (SA) has been performed by many years for the treatment of several conditions, including osteoarthritis and proximal humeral fractures following trauma. Surgical site infection (SSI) following Shoulder arthroplasty remains a challenge, contributing to increased morbidity and costs. Identification of risk factors may help implementing adequate strategies to prevent infection. We aimed to identify pre- and intra-operative risk factors associated with deep infections after Shoulder arthroplasty. Methods: An unmatched case-control study was conducted to describe the prevalence, clinical and microbiological findings, and to evaluate patient and surgical risk factors for prosthetic shoulder infection (PSI), among 158 patients who underwent SA due to any reason, at a tertiary public university institution. Risk factors for PSI was assessed by uni- and multivariate analyses using multiple logistic regression. Results: 168 SA from 158 patients were analyzed, with an overall infection rate of 9.5% (16/168 cases). Subjects undergoing SA with American Society of Anesthesiologists (ASA) grade III or higher (odds ratio [OR] = 5.30, 95% confidence interval [CI] = 1.58-17.79, p < 0.013) and presenting local hematoma after surgery (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.09-46.09, p = 0.04) had higher risk for PSI on univariate analysis. However, only ASA score grade III or higher remained significant on multivariate analysis (OR = 4.74, 95% CI = 1.33-16.92, p = 0.016). Gram-positive cocci and Gram-negative bacilli were equally isolated in 50% of cases; however, the most commonly detected bacterium was Pseudomonas aeruginosa (18.7%). Conclusion: This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.

Reconstrução cirúrgica de reabsorção condilar progressiva severa: relato de caso / Surgical reconstruction of severe progressive condylar resorption: case report

A reabsorção condilar progressiva é uma condição de etiologia controversa, caracterizada pela diminuição gradual do volume do côndilo mandibular, podendo o paciente apresentar, ao exame clínico, sinais e sintomas, como instabilidade oclusal e esquelética, oclusão classe II, mordida aberta anterior, dor e retrognatismo mandibular. Dentre os métodos terapêuticos para o seu tratamento, destacam-se a utilização de enxertos e próteses articulares, associados ou não à cirurgia ortognática para a reconstrução do côndilo mandibular. Este trabalho tem como objetivo relatar o caso clínico de uma paciente do sexo feminino, 28 anos de idade, portadora de artrite reumatoide juvenil, com presença de reabsorção condilar progressiva severa, abertura bucal máxima de 20 mm, dispneia noturna, retrusão mandibular e perfil facial convexo. Ela foi tratada no Hospital Federal dos Servidores do Estado por meio de cirurgia ortognática maxilomandibular com rotação anti-horária do plano oclusal e instalação de prótese condilar bilateral customizada TMJ Concepts®. A reconstrução total proporcionou uma perfeita adaptação à estrutura óssea remanescente, com melhora estético-funcional da paciente. Segue em controle pós operatório de dois anos, sem recidiva e com oclusão satisfatória... (AU)

Progressive condylar resorption is a controversial etiology condition characterized by the gradual decrease in the condylar volume, and the patient may present in clinical examination signs and symptoms such as occlusal and skeletal instability, occlusion Class II, anterior open bite, pain and retrognathism mandibular. Among the therapeutic methods for their treatment, it highlights the use of grafts and prosthetic joint, with or without orthognathic surgery for the reconstruction of the mandibular condyle. The purpose this study is to report the case of a female patient, 28 years old, holder of juvenile rheumatoid arthritis, with the presence of severe progressive condylar resorption, maximum mouth opening 20 mm, nocturnal dyspnoea, mandibular retraction and convex facial profile. It was treated at the Hospital Federal dos Servidores do Estado through orthognathic surgery maxilomandibular with counterclockwise rotation of the occlusal plane and installation of customized bilateral condylar prosthesis TMJ Concepts®. The total reconstruction provided a perfect adaptation to the remaining bone structure, aesthetic and functional improvement of the patient. The same goes for postoperative control two years without recurrence and satisfactory occlusion... (AU)

Tomografía computarizada de doble energía: nueva tecnología para la reducción de artefactos de metal / Dual-energy computed tomography: new technology for metal artifacts reduction

Introducción: El objetivo fue explorar la utilidad de la tomografía computarizada de doble energía mediante tecnología de imágenes espectrales gemstone y de un programa destinado a la reducción de artefactos de metal (MARS), para evaluar tejidos periprotésicos, y la interpretabilidad diagnóstica de patologías relacionadas con implantes. Materiales y Métodos: Se comparó la densidad ósea, de partes blandas y de grasa en el tejido periprotésico y en tejido de control sin implante, utilizando un escáner de alta definición de tomografía computarizada de doble energía tanto en imágenes policromáticas convencionales, como en monocromáticas virtuales con MARS, en 80 pacientes con prótesis metálicas en diversas regiones musculoesqueléticas. Se valoró la calidad de imagen y la interpretabilidad diagnóstica mediante la escala de Likert. Resultados: Con imágenes policromáticas hubo diferencias significativas entre el área periprotésica en los tres tejidos respecto a los controles (p <0,0001); sin diferencias significativas utilizando imágenes espectrales monocromáticas virtuales-MARS (hueso p = 0,053, partes blandas p = 0,32 y grasa p = 0,13), con más similitud con el tejido normal. Los niveles de ruido fueron significativamente mayores con imágenes policromáticas (p <0,0001) que con imágenes espectrales monocromáticas virtuales-MARS. Se consideraron no interpretables todas las regiones periprotésicas en las imágenes policromáticas y 11 (9%) en las imágenes espectrales monocromáticas virtuales-MARS. No hubo diferencias significativas en la dosis de radiación comparada con la del grupo control (p = 0,21). Conclusiones: La tomografía computarizada de doble energía puede reducir los artefactos periprotésicos, logrando un significativo incremento en la capacidad de identificar tejidos y la interpretabilidad diagnóstica de posibles patologías relacionadas con implantes. Nivel de Evidencia: II

Introduction: To explore the usefulness of dual energy imaging using gemstone spectral imaging technology and a dedicated software for metal artifact reduction (MARS) for the evaluation of periprosthetic tissues, and to assess image interpretability of implant-related complications. Methods: Signal density measurements were performed in periprosthetic and remote (control) areas in bone, soft tissue, and fat among 80 patients using a high definition scanner. Polychromatic images and virtual monochromatic spectral images with MARS were obtained, and image quality and diagnostic interpretability were evaluated using a Likert scale. Results: Using polychromatic images, the periprosthetic area showed significant differences compared to the remote areas among the three tissue explored (p<0.0001 for all); with no significant differences using virtual monochromatic spectral images-MARS (bone p=0.053, soft tissue p=0.32, fat p=0.13), suggesting similar signal density compared to normal (remote) tissue. Furthermore, periprosthetic polychromatic image noise levels were significantly higher than with virtual monochromatic spectral images-MARS (p<0.0001). All periprosthetic areas were deemed non-interpretable using polychromatic images, compared to 11 (9%) using virtual monochromatic spectral images-MARS. There were no differences in radiation dose compared to control group (p=0.21). Conclusions: Virtual monochromatic spectral images-MARS technology has the ability to reduce periprosthetic artifacts, achieving a significant increase to identify tissues and diagnostic interpretability of complications related to the implants. Level of Evidence: II

Functional assessment of endoprosthesis in the treatment of bone tumors / Avaliação funcional das endopróteses no tratamento de tumores ósseos

ABSTRACT OBJECTIVES: Evaluate the functional grade of these patients and to identify the types of complications found that influenced the average life span of endoprostheses the functions of the operated limb. METHODS: We analyzed 14 post-operative cases of endoprosthesis, patients with malignant bone tumors and aggressive benign bone tumors submitted to surgery between 2004 and 2014. The evaluation system used was proposed by Enneking, recommended by the Musculoskeletal Tumor Society (MSTS), in addition to the radiologic evaluation. RESULTS: Endoprosthesis are excellent choices for the treatment of bone tumors with limb preservation in relation to pain, strength, and patient's emotional acceptance. Another factor for good results is the immediate weight-bearing capacity, generating a greater independence. CONCLUSION: The authors conclude that all patients classified the therapy as excellent/good, regardless of the type of prosthesis used, extent of injury, and/or type of tumor resection performed.

RESUMO OBJETIVO: Avaliar o grau funcional desses pacientes e identificar os tipos de complicações encontradas e que influenciaram na sobrevida das endopróteses e na função do membro operado. MÉTODOS: Foram analisados 14 pós-operatórios de endopróteses em pacientes portadores de tumores ósseos malignos e benignos agressivos com cirurgia entre 2004 e 2014. O sistema de avaliação foi o proposto por Enneking, preconizado pela Musculoskeletal Tumor Society (MSTS), além da avaliação radiográfica. RESULTADOS: As endopróteses são ótimas opções no tratamento de tumores ósseos com preservação do membro, em relação à dor, força e aceitação emocional do paciente. Outro fator para bons resultados é a capacidade de suporte de peso imediato, que gera uma independência maior. CONCLUSÃO: Todos os pacientes classificaram a terapia como excelente/boa, indiferentemente do tipo de prótese, extensão da lesão, tipo de tumor e ressecção feita.

Infecciones osteoarticulares en pacientes del Hospital del Instituto de Seguridad del Trabajador (IST) de Viña del Mar: periodo 2012-2013 / Osteoarticular infections in patients of the Hospital del Instituto de Seguridad del Trabajador in Viña del Mar (Chile): period 2012-2013

INTRODUCCIÓN: Las infecciones osteoarticulares son un desafío frecuente en la práctica traumatológica diaria. En Chile y en los distintos hospitales de la región de Valparaíso son escasos los trabajos con relación al tema, lo que es fundamental para optimizar el tratamiento, tanto quirúrgico como médico, de estas infecciones. OBJETIVOS: Describir las infecciones osteoarticulares del Hospital del IST de Viña del Mar durante el periodo 2012-2013. MATERIALES Y MÉTODO: Trabajo descriptivo retrospectivo de una serie de casos. Se revisaron las fichas clínicas de los pacientes que cursaron con alguna infección osteoarticular y se obtuvieron los datos demográficos y clínicos de cada paciente. RESULTADOS: Treinta pacientes fueron incluidos. Dieciséis (53,3%) fueron hombres con un promedio de edad de 38,5años. El 50% correspondieron a infecciones asociadas a la atención de salud. Las principales infecciones fueron asociadas a material de osteosíntesis. El agente más frecuente fue el Staphylococcus aureus meticilinosensible (SAMS). En la mayoría de los casos se realizó aseo quirúrgico, toma de cultivos e inicio de antibióticos con ceftriaxona más clindamicina. CONCLUSIONES: Las infecciones osteoarticulares ocurrieron principalmente en hombres jóvenes, fueron infecciones asociadas a material de osteosíntesis y producidas por SAMS.

INTRODUCTION: Osteoarticular infections are a common challenge in everyday trauma practice. In Chile, and in different hospitals in the region of Valparaiso, there are few studies on the issue, which is essential to optimise both surgical and medical treatment of these infections. OBJECTIVES: To describe the osteoarticular infections in the Hospital del Instituto de Seguridad del Trabajador (IST) of Viña del Mar during the 2012-2013 period. MATERIALS AND METHODS: A retrospective descriptive study was performed on a series of cases. A review was made of the medical records of patients with any osteoarticular infection. Demographic and clinical data were obtained from each patient. RESULTS: Of the total of 30 patients included, 16 (53.3%) were male with a mean age of 38.5 years. Half (50%) of the infections were associated with health care. Major infections were associated with osteosynthesis material. The most frequent agent was Methicillin Susceptible Staphylococcus aureus (MSSA). In most cases surgical cleanliness, taking of microbiological cultures, and antibiotic treatment with ceftriaxone plus clindamycin, was performed. CONCLUSIONS: Osteoarticular infections occurred mainly in young men, were infections associated to osteosynthesis material, and caused by MSSA.

Efeito do filme de carbono DLC aplicado por plasma como recobrimento em Polietileno de Ultra Densidade e Alto Peso Molecular (UHWPE) e planejamento virtual utilizando a técnica de elementos finitos em cirurgias de próteses totais da ATM / The effect of DLC film applied by plasma coating deposition of Ultra high molecular weight polyethylene (UHWPE) in total ATM prosthesis and it virtual planning using the FEA technique

Este trabalho teve por objetivo avaliar o efeito do filme de carbono (DLC) aplicado por plasma como recobrimento da liga de Ti -6Al-4V e do polietileno de alto peso molecular (UHMWPE) em prótese totais de ATM, com a finalidade de melhorar suas propriedades bio-tribológicas. Outro aspecto abordado neste trabalho a aplicação do planejamento virtual utilizando a técnica de elementos finitos (FEA), na apresentação de um caso clínico, colocando a importância do cirurgião de conhecer a fundo tanto o planejamento cirúrgico quanto o desenvolvimento da prótese customizadas (TMJ), e assim evitar possíveis falhas biomecânicas. Material: Para o desenvolvimento deste trabalho primeiramente foram utilizados 40 corpos de prova de Ti-6Al-V, dos quais 15 foram recobertas com um DLC e 15 por DLC-Ag pelo método de deposição químico (PECVD), e 10 foram mantidos sem recobrimento como controle. Além disso, foram confeccionados 30 corpos de prova de UHMWPE, dos quais, 15 foram recobertas por DLC pelo sistema de deposição físico (CVD) e 15 foram mantidas sem recobrimento como controle. Métodos: Foram avaliadas as características superficiais das amostras, adesão em simulador de fadiga deslizante reproduzindo o trabalho condili fossapo 2000,000 de ciclos em banho com ringuer lactato a 36 graus, a uma carga 200 N. As amostras com filmes foram submetidas a teste de citotoxicidade com células osteoblásticas. Resultados: As células se mostraram uma biocompatibilidade significativa com as amostras portando filme de DLC em substrato Ti6Al4v, se mostrando inerte ao polietileno. Neste estudo também foi apresentado um caso clinico, paciente com 12 anos de idade genero feminino, portadora de anquilose bilateral da ATM relatou já ter sido submetida a cirurgias repetidas sem sucesso, apresentando deformidade esqueletal classe II, em consequência da anquilose temporomandibular,abertura bucal limitada inicial (4,9 mm) e pós cirúrgico reconstrução bilateral com prótese total de ATM ...

This study aimed to evaluate the effect of carbon film (DLC) applied by plasma ascoating the Ti-6Al-4V alloy and ultra high molecular weight polyethylene(UHMWPE) in total TMJ prosthesis, in order to improve their bio-tribologicalproperties. Another aspects addressed in this work are the application of virtualplanning using the technique of finite element (FEA) and the presentation of a case, placing the importance of the surgeon to know the background both surgical planning and the development of customized prosthesis (TMJ) and thus avoid possible biomechanical faults. Material: For the development of this work were first used 40 specimens of Ti-6Al-V, of which 15 were coated with a DLC and 15 DLC-Ag by chemical deposition method (PECVD), and 10 were kept without coating as control. In addition, they made 30 UHMWPE specimens, of which 15 were coated with DLC by physical deposition system (CVD) and 15 were maintained without coating as a control. Methods: The surface characteristics of the samples were evaluated for adhesion sliding fatigue tester reproducing the work condili fossapo 2000.000 cycles in banhocom ringuer lactate at 36 degrees,to a load 200 N. The film samples were subjected to cytotoxicity testing inosteoblastic cells. Results: The cells showed a significant biocompatibility with samples carrying DLC film on Ti6Al4V substrate, showing inert to thepolyethylene. This study also presented a clinical case patient with 12 years offemale gender age, bearer of bilateral ankylosis of the TMJ reported having been subjected to repeated unsuccessful attempts, with deformity skeletal class II, as a result of temporomandibular ankylosis, limited mouth opening initial (4.9 mm) and post surgical bilateral reconstruction with customized ATM denture after surgery, showed up with an opening (23 mm) after one year, with a significant improvement for food and severe sleep apnea. Conclusion: Dlc titanium within the parameterswe can deposition, is presented..

Arthroplastie cervico-céphalique pour fracture du col fémoral à Brazzaville: résultats anatomiques et fonctionnels au recul de 28 mois

Introduction: Les fractures du col du fémur sont fréquentes chez le sujet âgé. Elles sont en général traitées par des prothèses cervico-céphaliques. Le but de cette étude était d'évaluer les résultats anatomiques et fonctionnels obtenus avec ce type de prothèse. Matériel et méthodes: Cette étude rétrospective réalisée entre janvier 2008 et mai 2014 a concerné 30 patients totalisant 31 fractures. L'âge moyen était 71 ans (42 -87ans). On notait quatre fractures Garden III et 27 Garden IV. Vingt-sept patients étaient classés ASA II et trois patients ASA I. Le score de Parker était côté à 9/9 chez 23 patients et à 6/9 chez sept. Les prothèses étaient la prothèse de Moore (n=28 ; 90%), la prothèse de Thompson (n= 2 ; 7%) et la prothèse de Merle d'Aubigné(n= 1; 3%). Les résultats anatomiques ont été évalués selon les critères de Sharif. Les résultats fonctionnels ont été analysés selon Postel Merle d'Aubigné et Parker. Le recul moyen était 28 mois (6-61 mois). Résultats: Initialement toutes les prothèses étaient bien implantées. Au dernier recul, les complications anatomiques étaient une cotyloïdite (n=7), une bascule en varus (n=4) une prothèse perchée par lyse de l'éperon de Merckel (n=3), un enfoncement de la prothèse (n=7), une fracture périprothétique (n=1), et une subluxation de la prothèse (n=1). Selon Postel Merle d'Aubigné les résultats étaient très bons (n=1 ; 3%), bons (n=3 ;10%), moyens (n=4 ; 13%) , médiocres (n=14 ; 47%), et mauvais (n=8 ; 27%).Selon Parker, 24 patients étaient côtés à 7/9, cinq à 6/9 et un à 0. Conclusion: Au recul moyen de 28 mois les résultats des prothèses cervico-céphaliques n'étaient pas satisfaisants. Par nécessité, elles restent une option thérapeutique dans notre contexte socio-économique