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Article in Spanish | LILACS, BINACIS | ID: biblio-1367125


Objetivo: Describir los tiempos de internación, cirugía y rehabilitación de una serie de pacientes con cadera flotante. El objetivo secundario fue comparar los resultados obtenidos en función de la reinserción laboral con los de pacientes que sufrieron fracturas de pelvis o acetábulo sin fractura femoral asociada. Materiales y Métodos: Estudio descriptivo, retrospectivo y multicéntrico de pacientes con trauma de pelvis y acetábulo de alta energía, divididos en dos grupos de estudio según la presencia de fractura de fémur asociada homolateral (cadera flotante) para su comparación, durante el período comprendido entre enero de 2014 y marzo de 2019. Resultados: Se incluyó a 102 pacientes con trauma de pelvis o acetábulo agrupados en 2 poblaciones según la presencia de cadera flotante (cadera flotante 23; pelvis/acetábulo 79). Las medianas de días de internación [cadera flotante 15,5 (rango 4-193); pelvis/acetábulo 7 (rango 3-31); p = 0,0001] y de la cantidad de cirugías por paciente [cadera flotante 5 (rango 3-8); pelvis/acetábulo 2 (rango 1-4); p = 0,0001] fueron mayores en los pacientes con cadera flotante. Además, la incapacidad laboral temporaria fue más alta (p = 0,00012), sin diferencias significativas en la tasa de recalificación laboral (p = 0,11). Conclusión: La asociación de la lesión cadera flotante aumentó significativamente el tiempo de internación, los procedimientos quirúrgicos necesarios y el tiempo de recuperación según la incapacidad laboral temporaria en pacientes con trauma de pelvis o acetábulo. Nivel de Evidencia: III

Objective: We aim to describe the lengths of hospitalization, surgery, and rehabilitation of a series of patients with floating hip. As a secondary objective, to compare the outcomes obtained in terms of return to work in patients who had suffered fractures of the pelvis or acetabulum without an associated femoral fracture. Materials and Methods: Descriptive, retrospective, and multicenter study of patients with high-energy trauma to the pelvis and acetabulum divided into two study populations according to the presence of associated ipsilateral femur fracture (floating hip) for comparison, during the period January 2014 - March 2019. Results: 102 patients with pelvis and/or acetabulum trauma were included, grouped into 2 populations according to the presence of a float-ing hip (Floating hip: 23 patients; Pelvis/acetabulum: 79 patients). The median days of hospitalization [floating hip: median = 15.5 (range = 4-193); pelvis/acetabulum: 7 (3-31); p = 0.0001] and the number of surgeries per patient [FH: median = 5 (range = 3-8); pelvis/acetabulum: 2 (1-4); p = 0.0001] were higher in patients with floating hip. Additionally, temporary work disability was higher (p = 0.00012), with no significant differences in the rate of job retraining (p = 0.11). Conclusion: Floating hip significantly increased the length of hospitalization, necessary surgical procedures, and recovery times according to temporary work disability in patients with trauma to the pelvis and/or acetabulum. Level of Evidence: III

Adult , Pelvis/injuries , Treatment Outcome , Femur/injuries , Hip Fractures , Acetabulum/injuries
Article in Chinese | WPRIM | ID: wpr-928320


OBJECTIVE@#To investigate whether the anteversion angle of acetabular prosthesis can be evaluated on the anteroposterior X-ray film of common double hip joint.@*METHODS@#Total 32 patients(41 hips) after total hip arthroplasty were selected, including 18 males and 14 females, aged(66.2±4.1) years. All patients completed the positive X-ray film of both hips and plain CT scan of pelvis after operation. Acetabular anteversion was measured by plain CT scan of pelvis, and measured by Saka and other measurement formulas on X-ray film.@*RESULTS@#The acetabular anteversion measured by X-ray film was(16.2±5.0)° and that measured by CT was (31.8±9.7)°(P=0.00). In addition, there was a significant linear correlation between X-ray film and CT(Pearson correlation coefficient (r=0.84, P=0.00).@*CONCLUSION@#CT can accurately measure the acetabular anteversion, but it has obvious disadvantages, such as large radiation, high cost, phantom CT artifact and so on. Although Saka measurement formula can not directly obtain the accurate acetabular anteversion as CT measurement, it has a high correlation with the acetabular anteversion measured by CT. Therefore, the method proposed in this study can also preliminarily evaluate the acetabular anteversion.

Acetabulum/surgery , Arthroplasty, Replacement, Hip/methods , Female , Hip Joint/surgery , Hip Prosthesis , Humans , Male , Pelvis
Article in Chinese | WPRIM | ID: wpr-928270


Developmental dysplasia of the hip (DDH) is a major cause of hip arthritis and ultimately total hip arthroplasty. Due to the dysplastic acetabulum, how to place the acetabular cup becomes a challenge in acetabular reconstruction for such patients. Especially in the acetabula classified as Crowe typeⅡand type Ⅲ, the dislocation of the femoral head causes bone defects above the true acetabulum, which will affect the stability of the acetabular cup when the acetabular reconstruction is performed at the true acetabulum. Many acetabular reconstruction methods such as bone grafting, the use of small acetabular cups, socket medialization technique, and high hip center technique are used to increase the host bone coverage of the cup. However, each method has its own shortcomings that can not be ignored so that there is no unified conclusion on the acetabular reconstruction methods for Crowe typeⅡand type Ⅲ hip dysplasia. This article summarized and evaluated various reconstruction methods in combination with the acetabular morphology of DDH, and put forward the research direction in the future.

Acetabulum/surgery , Arthroplasty, Replacement, Hip , Developmental Dysplasia of the Hip , Hip Dislocation/surgery , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Humans , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928260


OBJECTIVE@#To investigate the clinical effect of porous tantalum Jumbo cup on acetabular reconstruction in revision of total hip arthroplasty.@*METHODS@#From September 2014 to December 2017, 18 patients(18 hips) with acetabular defect were reconstructed by porous tantalum Jumbo cup technology, including 6 males and 12 females;the age ranged from 54 to 76 years old with an average of(63.8±15.3) years. There were 6 cases of paprosky typeⅡA, 8 cases of typeⅡB, 2 cases of typeⅡC and 2 cases of type Ⅲ a. Harris score and visual analogue scale (VAS) were performed before and after operation. Imaging examination was performed to evaluate the position of hip rotation center and prosthesis, and to judge whether acetabular loosening, displacement and complications existed.@*RESULTS@#All cases were followed up for 13 to 49 months, with an average of 20.6 months. Harris score increased from 54.6±4.7 to 86.5±3.2 one year after operation(P<0.01), and VAS score decreased from 6.8±0.7 to 0.8±0.6 one year after operation (P<0.01). The transverse coordinate of hip rotation center was (3.52±0.72) cm before operation and (3.47±0.54) cm after operation (P>0.05). The longitudinal coordinate of hip rotation center was improved from (3.02±0.84) cm before operation to (2.35±0.53) cm after operation (P<0.01). During the follow-up period, the Jumbo cup was well fixed without loosening and displacement, the acetabular cup had bone ingrowth in varying degrees, and no light transmission line and osteolysis around the acetabular cup were found. No complications such as infection and nerve injury occurred.@*CONCLUSION@#The method of reconstructing acetabular bone defect with porous tantalum Jumbo cup is simple and easy, the early stability of acetabulum is good, and the short-term follow-up effect is good.

Acetabulum/surgery , Aged , Arthroplasty, Replacement, Hip , Female , Follow-Up Studies , Hip Prosthesis , Humans , Male , Middle Aged , Porosity , Prosthesis Failure , Reoperation , Retrospective Studies , Tantalum , Treatment Outcome
Rev. bras. ortop ; 56(4): 513-516, July-Aug. 2021. graf
Article in English | LILACS | ID: biblio-1341169


Abstract Objective The objective of the present work was to compare the measurement of acetabular component version on anteroposterior (AP) and on cross-table radiographs after total hip arthroplasty (THA). Methods Radiographs of 60 hips with a primary THA were selected. Version was calculated on the AP radiograph using the Lewinnek method and, on the cross-table, using the Woo and Morrey direct method. Results Mean and standard deviation (SD) were different on both radiographs, being 9.7° ± 5.5° on the AP, whereas in the cross-table the measurements were 20.6° ± 8.4° (p < 0.001). Minding our aim of 10°, the cross-table measurements were statistically different from it (p < 0.001), while the AP measurement did not differ (p = 0.716). Conclusion The present study showed that the best way to correctly evaluate the acetabular component positioning following a THA is by measuring anteversion and abduction on an AP radiograph after confirming, in a cross-table radiograph, that the component is not retroverted.

Resumo Objetivo O objetivo do presente trabalho foi comparar a medição da versão do componente acetabular em radiografias em incidência anteroposterior (AP) e crosstable após artroplastia total do quadril (ATQ). Métodos Foram selecionadas radiografias de 60 quadris com ATQ primário. A versão foi calculada na radiografia AP usando o método de Lewinnek e, na cross-table, usando o método direto do Woo e Morrey. Resultados A média e o desvio padrão (DP) foram diferentes em ambas as radiografias, sendo 9,7° ± 5,5° no AP, enquanto na cross-table foram 20,6° ± 8,4° (p < 0,001). Considerando nosso objetivo de 10°, as medidas da cross-table foram estatisticamente diferentes dele (p < 0,001), enquanto a medição AP não diferiu (p = 0,716). Conclusão O presente estudo mostrou que a melhor maneira de avaliar corretamente o posicionamento do componente acetabular após uma ATQ é medindo a anteversão e a abdução em uma radiografia AP após confirmar, em uma radiografia cross-table, que o componente não é retrovertido.

Radiography , Arthroplasty, Replacement, Hip , Acetabulum
Rev. cuba. ortop. traumatol ; 35(1): e347, 2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1289553


Introducción: Las convulsiones pueden producir una tensión muscular significativa capaz de fracturar el hueso. Se halló que el aumento significativo en la incidencia de fracturas se encuentra dentro del grupo de edad entre 45 a 64 años, lo que demuestra que los epilépticos no solo son más vulnerables a las fracturas, sino que tienen un comienzo de fractura más precoz. Las medidas de prevención comprenden suplementos de calcio, vitamina D, densitometría ósea y tratamiento con bifosfonatos, que deben reforzarse en pacientes con epilepsia que tienen riesgo de osteoporosis. Objetivo: Presentar casos de fracturas extracapsular e intracapsular de la cadera por convulsiones epilépticas, atendidos en el hospital Víctor Lazarte Echegaray, Trujillo, Perú, en el periodo comprendido entre 2013 y 2019. Presentación de los casos: Se reporta dos casos de fractura de cadera por convulsiones epilépticas, uno con fractura del acetábulo e iliaco izquierdo y otro a nivel del cuello femoral y subtrocantérica. Conclusiones: Las personas con convulsiones epilépticas poseen un mayor peligro de fracturas, por consiguiente se recomienda a los médicos que maximicen su conciencia sobre las fracturas relacionadas a convulsiones, en especial a pacientes con dolor postictal, debido a que los síntomas pueden ser inespecíficos y una mala interpretación puede impedir la rehabilitación(AU)

Introduction: Seizures can produce significant muscle tension capable of fracturing the bone. The significant increase in the incidence of fractures was found to be within the age group between 45 and 64 years, which shows that epileptics are not only more vulnerable to fractures, but also have earlier fracture onset. Prevention measures include calcium supplements, vitamin D, bone densitometry, and bisphosphonate treatment that should be reinforced in patients with epilepsy who are at risk for osteoporosis. Objective: To present cases of hip fractures due to epileptic seizures, treated at Víctor Lazarte Echegaray Hospital, Trujillo, Peru, from 2013 to 2019. Case report: Cases of hip fracture due to epileptic seizures have been reported, one with fracture of the acetabulum and left iliac and another at the level of the femoral and subtrochanteric neck. Conclusions: Individuals with epileptic seizures have greater risk of fractures, it is recommended that physicians maximize their awareness of seizure-related fractures, especially in patients with postictal pain, since the symptoms can be nonspecific and misinterpretation can prevent rehabilitation(AU)

Humans , Adult , Middle Aged , Seizures/etiology , Hip Fractures/surgery , Hip Fractures/complications , Peru , Arthroplasty/methods , Acetabulum/surgery
Article in Spanish | LILACS, BINACIS | ID: biblio-1353913


Las fracturas por insuficiencia subcondral son una causa poco frecuente de cadera dolorosa. A diferencia de las fracturas traumáticas agudas, las fracturas por insuficiencia del acetábulo son menos frecuentes que las femorales. Ocurren habitualmente en mujeres posmenopáusicas con comorbilidades. Su diagnóstico inicial suele ser dificultoso y la sospecha clínica es de gran importancia. La resonancia magnética es una herramienta fundamental para detectar este cuadro. Subestimar estas lesiones puede llevar al desarrollo de una artrosis rápidamente progresiva y al reemplazo articular como desenlace. Se presenta el caso de una paciente de 68 años con una fractura por insuficiencia subcondral del acetábulo a quien se le indicó una artroplastia total de cadera no cementada. Nivel de Evidencia: IV

Subchondral insufficiency fractures are a rare cause of hip pain. Unlike acute traumatic fractures, acetabulum insufficiency fractures are less common than femoral fractures. They commonly occur in postmenopausal women with comorbidities. Its initial diagnosis is usually difficult and clinical suspicion is of great importance. Magnetic resonance imaging (MRI) is a fundamental tool for the detection of this pathology. Underestimating these injuries can lead to the development of rapidly progressive osteoarthritis and joint replacement as an outcome. We present the case of a 68-year-old patient with a subchondral insufficiency fracture of the acetabulum who underwent uncemented total hip arthroplasty. Level of Evidence: IV

Aged , Osteoarthritis, Hip , Fractures, Stress , Arthroplasty, Replacement, Hip , Hip Joint/pathology , Acetabulum/injuries
Rev. colomb. ortop. traumatol ; 35(1): 99-104, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378587


Se presenta un Caso Clínico de una paciente de género femenino, 90 años 6 meses de edad, con diagnóstico inicial de Coxartrosis Bilateral de Cadera. Se le realizó Reemplazo Total de Cadera hace 30 años del lado izquierdo (1990) con una Prótesis de Roy Camille, y hace 25 años se intervino el lado derecho (1997) con una Prótesis Bipolar Cementada. En el año 2019 se llevó a Revisión de Prótesis de Cadera.

We present a Clinical Case of a female patient, 90 years 6 months of age, with an initial diagnosis of Bilateral Hip Coxarthrosis. Total Hip Replacement was performed 30 years ago on the left side (1990) with Roy Camille Prosthesis, and 25 years ago the right side (1997) was intervened with a Cemented Bipolar Prosthesis. In the year 2019 he took o hip Prosthesis Review.

Humans , Prostheses and Implants , Arthroplasty, Replacement, Hip , Osteotomy , Pain , Fractures, Bone , Acetabulum
Article in Chinese | WPRIM | ID: wpr-888322


OBJECTIVE@#To investigate the application value of liquid crystal digital display goniometer in total hip arthroplasty.@*METHODS@#From January 2018 to December 2019, 83 patients underwent primary total hip arthroplasty, including 28 males and 55 females, aged 42 to 81 (70.4±7.9) years. There were 63 cases of femoral neck fracture and 20 cases of avascular necrosis of femoral head. All patients used liquid crystal digital goniometer to control the anteversion of acetabular cup prosthesis during operation, and CT scanning was used to measure the anteversion of acetabular cup after operation. The two methods were compared to understand the accuracy of using liquid crystal digital goniometer.@*RESULTS@#Postoperative CT measurement showed that the acetabular anteversion of all patients was in the safe area advocated by Lewinnek. The anteversion angle of acetabular cup measured by liquid crystal digital goniometer was 14.20(12.80 to 15.40)°, and the anteversion angle of acetabular cup measured by postoperative CT scan was 14.20 (13.40 to 15.50)°. There was no significant difference between the two (@*CONCLUSION@#It is an accurate and reliable method to control the anteversion of acetabular cup with liquid crystal digital display angle instrument, which has a good auxiliary reference value.

Acetabulum/surgery , Arthroplasty, Replacement, Hip , Female , Hip Prosthesis , Humans , Liquid Crystals , Male , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-879468


Since the concept of "safe area" put forward by Lewinnek, it has been widely recognized. While in recent years, many scholars have found that even if the acetabular prosthesis was placed on the "safe area", there were still many unexplained dislocation after total hip arthroplasty. And scholars began to question whether the "safe area" is really suitable for all patients. Spinal degeneration, deformity, lumbar fusion, etc. will lead to spine sagittal imbalance and changes in pelvic activity, which could lead to changes in acetabular orientation, and ultimately lead to edge loading, wear, impact, and even dislocation after total hip replacement. From the perspective of wear, impact and dislocation, it is determined by the functional positioning of the acetabular cup, not the anatomical positioning. The anatomical positioning and functional positioning of the neutral pelvic acetabular cup in the standing position can be considered equivalent. For pelvic rotation more than 20°, functional placement needs to be considered. In recent years, as the understanding of the internal relationship between the spine-pelvis-hip joint has become more and more profound, some scholars further classify the hip-spine relationship according to whether the spine is stiff or deformed, and propose corresponding acetabulums according to different types of hip-spine relationships The function of placement, so as to achieve a stable artificial hip joint. Therefore, it is of great significance to fully assess whether the patient's sagittal plane is balanced before surgery to guide artificial hip replacement surgery.

Acetabulum/surgery , Arthroplasty, Replacement, Hip , Hip Joint , Hip Prosthesis , Humans , Spine
Article in Chinese | WPRIM | ID: wpr-879418


OBJECTIVE@#To measure the maximum corridor parameters of the infra acetabular screw and evaluate the feasibility of screw insertion through digital analysis of the acetabular structure.@*METHODS@#The pelvic CT data of 100 patients who received plain pelvic CT scan from April 2013 to June 2015 were retrospectively analyzed. There were 50 males, aged 20 to 84 years, with an average age of (48.42±17.48) years, and 50 females, aged 18 to 87 years, with an average age of (55.02±19.54) years. Patients with acetabular fractures, hip dysplasia, and metal implants in the acetabulum were excluded. Import CT data into Mimics software in DICOM format to generate a three-dimensional model, and find the axialprojection of the infra-acetabular corridor in the middle of the pubis ramus in the inlet view. A virtual screw was placed in the infra-acetabular space and measure the parameters including the diameter and the length of the maximum corridor, the distance from the insertion point to the pubic symphysis, to the anterosuperior iliac spine and to the medial edge of the pelvis. Then import the pelvic model into 3- matic software, establish the pelvic model anterior pelvic plane and median sagittal plane, and measure the angle between the screw axis and the two planes. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5 mm screw, and calculate the screw insertion rate.@*RESULTS@#In 100 cases, 49% of patients had a infra acetabular corridor with a diameter ≥5 mm, and the rate of screw placement in men was significantly higher than that in women. The average diameter of the maximum corridor of infra-acetabular screw was (4.86±1.72) mm, the average length was (94.04±8.29) mm, the average distance from the insertion point to the pubic symphysis was (60.92±4.84) mm, to the anterosuperior iliac spine was (85.15± 6.85) mm, and to the medial edge of the pelvis was (6.12±3.32) mm. The mean angle between the axis of the screw and the median sagittal plane was (-1.38±4.74)°, and the mean angle between the axis of the screw and the anterior pelvic plane was (56.77±7.93)°. There are significant differences between male and female measured parameters, except for the angle between the screw axis and the anterior pelvic plane. There was no statistically significant difference in the maximum corridor parameters of infra-acetabular screw on both sides of the pelvis.@*CONCLUSION@#This study shows that the insertion rate of infra-acetabular screws is low in local patients, and the feasibility of screw insertion should be fully evaluated before surgery.

Acetabulum/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Bone Screws , Feasibility Studies , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
Medwave ; 20(11): e8082, dic. 2020.
Article in English | LILACS | ID: biblio-1146066


PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

Humans , Male , Female , Adolescent , Adult , Young Adult , Osteotomy/methods , Arthroscopy/methods , Hip Dislocation, Congenital/surgery , Acetabulum/surgery , Osteotomy/adverse effects , Follow-Up Studies , Treatment Outcome , Hip Dislocation, Congenital/diagnostic imaging
Rev. bras. ortop ; 55(6): 708-714, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156187


Abstract Objective To evaluate the incidence of prosthetic instability in a consecutive series of 42 cases of total hip arthroplasty using dual mobility cup. Methods A retrospective study of 38 patients undergoing primary or revision total hip arthroplasty (THA) using the acetabular dual-mobility cup (DMC) implant between January 2012 and January 2018. The rates of complications and instability after surgery were evaluated. Results In total, 42 arthroplasties were performed in 38 patients, with a minimum follow-up of 16 months. The mean age of the sample was 60 years. In 38 cases, we used a cementless DMC, and, in the other 4 cases, a cemented DMC. There were no cases of early or late instability. Conclusion The series herein presented proves the good result of the DMC in cases of primary arthroplasty, complex and complicated cases of failed osteosynthesis of proximal femoral fractures, and revision for THA instability. The absence of episodes of prosthetic instability and complications in complex cases of primary and revision THA increases the confidence in this concept.

Resumo Objetivo Avaliar a incidência de instabilidade protética em uma série consecutiva de 42 casos de artroplastia total do quadril com uso do acetábulo de dupla mobilidade. Métodos Estudo retrospectivo de 39 pacientes que passaram por artroplastia total de quadril (ATQ) primária ou de revisão usando taça de dupla mobilidade (TDM) acetabular entre janeiro de 2012 e janeiro de 2018. Foram avaliadas as taxas de complicações e de instabilidade após a cirurgia. Resultados Foram feitas 42 artroplastias em 38 pacientes, com um seguimento mínimo de 16 meses. A média de idade da amostra foi de 60 anos. Em 38 casos, usamos TDM sem cimento, e nos outros 4 casos, TDM cimentada. Não houve instabilidade precoce ou tardia. Conclusão A série aqui apresentada prova o bom resultado da TDM em artroplastias primárias, casos complexos e complicados de falha de osteossíntese de fratura proximal do fêmur, e cirurgia de revisão por instabilidade na ATQ. A falta de episódios de instabilidade prostética e complicações em casos complexos de ATQ primária ou de revisão aumentou a confiança nesse conceito.

Humans , Male , Female , Adult , Middle Aged , Aged , Arthroplasty , Incidence , Retrospective Studies , Femoral Fractures , Fracture Fixation, Internal , Hip Prosthesis , Hospitals, University , Acetabulum
Rev. bras. ortop ; 55(5): 518-522, Sept.-Oct. 2020. graf
Article in English | LILACS | ID: biblio-1144214


Abstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.

Resumo O impacto femoroacetabular (IFA) é uma importante causa de dor no quadril, e a principal etiologia da osteoartrose do quadril no jovem. O IFA é caracterizado por alterações sutis da anatomia do acetábulo e do fêmur proximal que podem causar lesões do complexo condrolabial. O lábio é uma estrutura fibrocartilaginosa essencial na estabilidade articular. Três tipos de IFA são descritos: came (onde há uma anesfericidade da cabeça femoral), pincer (onde há uma sobrecobertura acetabular) e misto (que apresenta características de ambos). A etiologia do IFA está relacionada com características genéticas e ambientais. O conhecimento desta doença e sua fisiopatologia é essencial para o tratamento de pacientes que apresentam dor no quadril.

Humans , Pain , Sports Medicine , Wounds and Injuries , Osteoarthritis, Hip , Femur , Femoracetabular Impingement , Hip , Acetabulum
Rev. chil. ortop. traumatol ; 61(2): 40-46, oct. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1342377


OBJETIVO: Evaluar los resultados radiológicos a corto y mediano plazo de pacientes operados de fractura de pared posterior de acetábulo, describir la morfología de la fractura, presencia de lesiones asociadas y la necesidad de artroplastia total de cadera (ATC) durante la evolución. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 40 pacientes operados entre julio de 2012 y julio de 2017 por fractura de pared posterior de acetábulo. Treinta y siete hombres y tres mujeres con una edad promedio de 41 años fueron operados (mediana de seguimiento 17,7 meses). Se registró el mecanismo del accidente y presencia de lesiones asociadas. Se registraron el número de fragmentos que presentaba la fractura, presencia de impactación marginal, compromiso de la cabeza femoral, presencia de fragmentos intra-articulares y complicaciones postoperatorias. Para el análisis estadístico se utilizó el test de Wilcoxon. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Un 70% de los pacientes presentó luxación posterior. La mayoría de los pacientes presentó una fractura entre 2 y 5 fragmentos (70%), 47,5% de los pacientes presentó impactación marginal, 37,5% compromiso de la cabeza femoral en zona de carga, 30% fragmentos intra-articulares. La complicación que más frecuente se observó fue la artrosis post-traumática la cual se presentó en un 22,5%. Cinco pacientes (12,5%) requirieron ATC. CONCLUSIÓN: Aunque se categorizan dentro de los patrones simples, las fracturas de pared posterior son lesiones complejas. La tomografía axial computada preoperatoria es esencial para determinar lesiones intra-articulares dada su alta frecuencia y también permite realizar un buen plan preoperatorio.

OBJECTIVE: Evaluate radiologic results in short and medium-term in surgically treated patients with acetabular posterior wall fracture. Describe fracture morphology, the presence of associated lesions and the necessity of total hip arthroplasty (THA) during the evolution. MATERIALS AND METHODS: A retrospective-descriptive study design of 40 patients treated during July 2012 and July 2017 for acetabular posterior wall fracture. 37 men and 3 women, 41 years old mean age. The mean follow-up was 17.7 months. Accident mechanism and presence of associated lesions were registered, as well as the number of fragments of the fracture, the presence of marginal impaction, femoral head compromise, intra-articular fragments and postoperatory complications. Wilcoxon test was used for the statistical analysis. RESULTS: Every case resulted due to a high energy accident. 70% of patients had posterior luxation of the hip. 70% of patients presented 2 to 5 fragments. 47.5% of patients presented marginal impaction, 37.5% compromised femoral head and 30% intra-articular fragments. The most frequent complication was post-traumatic arthrosis, which appeared in 22.5% of patients. Five patients required THA. CONCLUSION: Though it is categorized as simple fracture pattern, posterior wall fractures are complex. Preoperatory CT scan is essential to determine intra-articular lesions due to its high frequency and permits to plan an adequate intervention.

Humans , Male , Female , Adult , Fractures, Bone/surgery , Fracture Fixation/methods , Acetabulum/injuries , Postoperative Complications , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Fractures, Bone/etiology , Fractures, Bone/diagnostic imaging , Fracture Fixation, Internal/methods , Acetabulum/surgery , Acetabulum/diagnostic imaging
Rev. bras. anestesiol ; 70(4): 443-447, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137201


Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.

Resumo Justificativa: Existem várias abordagens para a realização do Bloqueio do Quadrado Lombar (BQL) guiado por ultrassom. Diversas abordagens são descritas para a realização do BQL: paramediana lateral, posterior, anterior ou transmuscular e subcostal, todas com o objetivo de obter a máxima dispersão da solução injetada, usando-se alto volume e baixa concentração de anestésico local. Relato de caso: Nesta nova abordagem, a sonda de ultrassom curvilínea foi usada com o paciente em decúbito dorsal. A sonda foi posicionada longitudinalmente na linha axilar média para visualizar o Músculo Quadrado Lombar (MQL) no plano coronal. A agulha foi introduzida na direção cranial-caudal, e foram inseridos cateteres na Fáscia Toracolombar Anterior (FTLA) até uma distância de 4-5 cm, em 24 pacientes a serem submetidos à correção de fratura do acetábulo pela via anterior. O bisel da agulha e a dispersão do Anestésico Local (AL) eram visíveis em todos os pacientes. Os 24 pacientes, com exceção de quatro, apresentaram excelente analgesia perioperatória, baseando-se na estabilidade hemodinâmica e nos escores EVA de 2-3/10 nas primeiras 48 horas. Todos os pacientes receberam 1 g de paracetamol intravenoso a cada 8 horas. O escore EVA no período pós-operatório foi de 2-3/10, em 20 dos 24 pacientes. No período pós-operatório, quatro pacientes apresentaram queixa de dor persistente, necessitando de bolus de fentanil por via intravenosa e analgesia multimodal. O escore médio da EVA no pós-operatório foi 2,87 entre 0-12 horas; 3,14 entre 12-24 horas e 3,35 entre 24-48 horas pós-operatórias. Não houve complicações relacionadas ao bloqueio em nenhum paciente. Conclusão: A abordagem supina axilar média coronal para BQL anterior é eficaz e viável para BQL, e pode ser realizada com os pacientes em decúbito dorsal.

Humans , Male , Female , Pain, Postoperative/prevention & control , Anesthetics, Local/administration & dosage , Nerve Block/methods , Time Factors , Supine Position , Abdominal Muscles , Ultrasonography, Interventional , Acetabulum/surgery , Acetabulum/injuries , Acetaminophen/administration & dosage , Middle Aged , Nerve Block/adverse effects
Acta ortop. mex ; 34(2): 123-128, mar.-abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345100


Resumen: Introducción: El abordaje anterior de cadera fue descrito en 1881, desde entonces se han realizado diversos estudios que han demostrado ventajas significativas frente a los abordajes posterior y lateral directo de cadera. Material y método: Se llevó a cabo un estudio descriptivo con casos continuos no probabilísticos en el Instituto de Ciencias Forenses de Octubre de 2015 a Julio de 2017. Se describió anatomía y distancias a los paquetes vasculonerviosos. Se realizó correlación de Pearson y Rho de Spearman. Resultados: Se efectuaron 22 disecciones, el nervio femorocutáneo fue identificado en nueve especímenes, la distancia promedio del nervio femorocutáneo lateral al intervalo de Smith-Petersen fue 11.4 mm, se identificó la arteria circunfleja lateral ascendente debajo del recto femoral hacia la región central del abordaje, se colocaron los separadores alrededor de la articulación coxofemoral sin lesionar estructuras vitales, el separador más riesgoso se ubicó en la pared anterior del acetábulo, debajo del músculo iliopsoas con distancia promedio de 28.25 mm al paquete femoral. A mayor edad mayor distancia a los paquetes neurovasculares p < 0.05. Conclusiones: Alto nivel de seguridad del abordaje anterior para artroplastía de cadera, las distancias a estructuras vitales presentan un margen razonable, en artroplastía de cadera ofrece adecuada exposición de la articulación, visión directa del acetábulo y disección quirúrgica atraumática.

Abstract: Introduction: The anterior hip approach was described since 1881, since then several studies have been conducted that have shown significant advantages over the posterior and lateral direct approaches of the hip. Material and method: We conducted a descriptive study with continuous non-probabilistic cases at the Institute of Forensic Sciences from October 2015 to July 2017. Anatomy and distances were described to the neurovascular bundles. Correlation of Spearman's Pearson and Rho was performed. Results: 22 dissections were made, the Femorocutaneous Nerve was identified in 9 specimens, the average lateral Femorocutaneous Nerve distance at Smith-Petersen interval was 11.4 mm, We identified the Ascending Lateral Circumflex artery under the femoral rectum towards the central region of the approach, the separators could be placed around the coxofemoral joint without injuring vital structures, the riskier separator we place it in the anterior wall of the acetabulum, below the Psoasyland with an average distance 28.25 mm to the femoral package. The older you go, the longer the neurovascular bundles were located p < 0.05. Conclusions: High level of safety of the previous approach for hip replacement, distances to vital structures have a reasonable margin, hip replacement offers adequate joint exposure, direct acetabulum vision and atraumatic surgical dissection.

Arthroplasty, Replacement, Hip , Hip Joint/surgery , Femur , Acetabulum/surgery
Rev. bras. ortop ; 55(2): 247-253, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1138009


Abstract Objective This paper aims to compare clinical and radiographic features of symptomatic and asymptomatic hips in patients with unilateral femoroacetabular impingement syndrome (FAIS) and to establish a correlation between these findings. Methods This is a retrospective study, based on medical records of patients diagnosed with FAIS between January 2014 and April 2017. The patients were assessed clinically as per the International Hip Outcome Tool 33 (iHOT33) questionnaire, visual analogue pain scale, hip rotation, and hip and knee muscular strength. The radiographic evaluation consisted of measurements of the alpha angle, crossover signal, acetabular retroversion index, ischial spine signal, and posterior wall sign. Results A total of 45 patients were included in the study, with mean time from symptom onset to diagnosis of 28.6 months and mean iHOT33 score was 39.9. The mean medial rotation was 20.5º in symptomatic hip and 27.2º in asymptomatic hip (p < 0.001). The crossover signal was positive on 68.9% of the symptomatic hips and 55.6% of the asymptomatic hips (p = 0.03). The mean retroversion index was 0.15 in symptomatic hips and 0.11 in asymptomatic hips (p = 0.02). There was a positive correlation between the total time of symptoms and medial hip rotation reduction (p = 0.04) and between body mass index (BMI) and medial hip rotation reduction (p = 0.02). Conclusion When comparing clinical and radiographic features, we observed reduction of medial rotation and increase of acetabular retroversion index in the symptomatic hip, as well as association between the long symptom time and the high BMI with loss of medial rotation of the hips.

Resumo Objetivos Comparar características clínicas e radiográficas entre quadril sintomático e assintomático em pacientes com síndrome do impacto femoroacetabular unilateral e estabelecer correlações entre os achados. Métodos Estudo retrospectivo, que consultou prontuários de pacientes com síndrome do impacto femoroacetabular, entre janeiro de 2014 e abril de 2017. Os pacientes foram avaliados clinicamente pelo questionário International Hip Outcome Tool 33 (iHOT33), escala visual analógica de dor, amplitude de rotação de quadril e força muscular de quadril e joelho. A avaliação radiográfica foi composta por mensurações do ângulo alfa, sinal do cruzamento, índice de retroversão acetabular, sinal da espinha isquiática e sinal da parede posterior do acetábulo. Resultados Foram incluídos no estudo 45 prontuários de pacientes, com tempo médio de sintomas até o diagnóstico de 28,6 meses e pontuação média no iHOT33 de 39,9. O valor médio de rotação medial do quadril sintomático foi de 20,5º e do assintomático 27,2º, com (p < 0,001). A positividade do sinal do cruzamento para quadril sintomático foi de 68,9% e do assintomático 55,6% (p = 0,03). Para índice de retroversão, o valor médio do quadril sintomático foi de 0,15 e do quadril assintomático foi 0,11 (p = 0,02). Encontramos correlação positiva entre o tempo de sintomas e a redução de amplitude de rotação medial de quadril (p = 0,04) e entre o índice de massa corpórea (IMC) e a redução amplitude de rotação medial de quadril (p = 0,02). Conclusão Ao comparar características clínicas e radiográficas, observamos redução de rotação medial e aumento do índice de retroversão acetabular no quadril sintomático, bem como associação entre o longo tempo de sintoma e o IMC elevado com perda de rotação medial dos quadris.

Humans , Signs and Symptoms , Pain Measurement , Carrier State , Medical Records , Retrospective Studies , Seismic Waves Amplitude , Femoracetabular Impingement , Knee , Acetabulum
Rev. bras. ortop ; 55(2): 239-246, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1137999


Abstract Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5º (20 o to 40º), and in the left 32.3º (20 o to 40º). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry (p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.

Resumo Objetivos O objetivo do presente trabalho é avaliar a deformidade dos ossos pélvicos e sua correlação com ângulo centro-borda acetabular (CE). Métodos Foi realizado um estudo prospectivo caso-controle, entre agosto de 2014 e abril de 2015. Os critérios de inclusão foram pacientes consecutivos com idades entre 20 e 60 anos. Os critérios de exclusão foram: doença metabólica, cirurgia prévia de quadril ou coluna, radiografia evidenciando artrose de quadril ≥ Tönnis 2, displasia do desenvolvimento do quadril (DDQ) severa, sobrecobertura acetabular global, sinal do cruzamento das linhas acetabulares, deformidades decorrentes de epifisiólise ou Legg-Perthes-Calveé, e radiografia sem qualidade adequada. Foram avaliados na radiografia anteroposterior (AP) de pelve: o ângulo CE, índice acetabular (IA), sinal do cruzamento das linhas acetabulares, mensuração do eixo horizontal e vertical da hemipelve superior e inferior (H1: Linha Horizontal 1, hemipelve superior; H2: Linha Horizontal 2, hemipelve superior; V1: Linha Vertical, hemipelve superior; HR: Linha Horizontal, hemipelve inferior; VR: Linha Vertical, hemipelve inferior). As mensurações H1, H2, V1, HR e VR foram consideradas assimétricas quando, na comparação de uma hemipelve em relação ao lado contralateral, evidenciou-se uma diferença > 5 mm. Os pacientes foram separados em dois grupos: controle e grupo 1. Resultados O total de pacientes avaliados no período foi de 228 (456 quadris). De acordo com os critérios estabelecidos, foram incluídos neste estudo 93 pacientes. A idade média foi de 39,9 anos (20 a 60 anos, desvio padrão [DP] = 10,5), e o ângulo CE médio do quadril direito foi de 31,5º (20º a 40º) e do esquerdo de 32,3º (20º a 40º). Um total de 38 pacientes foi incluído no grupo controle, sendo que com relação à H1, foi constatada aferição assimétrica em 4 casos (10,5%), H2 em 5 (13,1%), V1 em 7 (18,4%), HR em 5 (13,1%), e VR em 1 caso (2,63%). No grupo 1, foram incluídos 55 pacientes, sendo que com relação à H1, foi constatada aferição assimétrica em 24 casos (43,6%), H2 em 50 (90,9%), V1 em 28 (50,9%), HR em 16 (29,09%), e VR em 8 casos (14,5%). Na comparação entre o grupo controle e o grupo 1, observou-se diferença estatisticamente significativa para a assimetria das mensurações H1, H2 e V1 (p < 0,001). Conclusão No presente trabalho, evidenciou-se correlação entre variação do ângulo CE acetabular e assimetria da hemipelve superior. Os presentes autores acreditam que o melhor entendimento das alterações morfológicas pélvicas permite uma maior facilidade no diagnóstico das deformidades articulares do quadril.

Humans , Male , Female , Adult , Middle Aged , Osteoarthritis , Femur Head , Hip Dislocation , Acetabulum
Hip & Pelvis ; : 1-10, 2020.
Article in English | WPRIM | ID: wpr-811160


The use of three-dimensional (3D) printing is becoming more common, including in the field of orthopaedic surgery. There are currently four primary clinical applications for 3D-printing in hip and pelvic surgeries: (i) 3D-printed anatomical models for planning and surgery simulation, (ii) patient-specific instruments (PSI), (iii) generation of prostheses with 3D-additive manufacturing, and (iv) custom 3D-printed prostheses. Simulation surgery using a 3D-printed bone model allows surgeons to develop better surgical approaches, test the feasibility of procedures and determine optimal location and size for a prosthesis. PSI will help inform accurate bone cuts and prosthesis placement during surgery. Using 3D-additive manufacturing, especially with a trabecular pattern, is possible to produce a prosthesis mechanically stable and biocompatible prosthesis capable of promoting osseointergration. Custom implants are useful in patients with massive acetabular bone loss or periacetabular malignant bone tumors as they may improve the fit between implants and patient-specific anatomy. 3D-printing technology can improve surgical efficiency, shorten operation times and reduce exposure to radiation. This technology also offers new potential for treating complex hip joint diseases. Orthopaedic surgeons should develop guidelines to outline the most effective uses of 3D-printing technology to maximize patient benefits.

Acetabulum , Hip Joint , Hip , Humans , Models, Anatomic , Pelvis , Prostheses and Implants , Surgeons