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Hip & Pelvis ; : 17-25, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811158


PURPOSE: Although the number of hip arthroscopies is rapidly increasing in non-elderly patients, outcomes of this procedure in middle-aged patients are not well documented or clearly understood. The purpose of this study was to evaluate the clinical and radiological outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis.MATERIALS AND METHODS: This retrospective study analyzed 189 patients with early osteoarthritis of various diagnoses aged 40 years or older who underwent hip arthroscopy between January 2010 and December 2015. Clinical (e.g., modified Harris hip score [mHHS], hip outcome score-activities of daily living [HOS-ADL], visual analogue scale [VAS] for pain, range of motion) and radiological (change of Tönnis grade) outcomes were assessed at a minimum of 3-year follow-up.RESULTS: The mean preoperative and final mHHS and HOS-ADL improved from 61.2 and 60.6 to 79.5 and 81.8, respectively, while the VAS pain score decreased from 6.3 to 3.2 (P<0.001). Although the mean range of internal rotation and flexion increased from 14.2 and 100.7° preoperatively to 30.4 and 110.6° at 1-year postoperatively, they decreased slightly to 27.4 and 105.4° at the final follow-up, respectively. Eight cases (4.2%) underwent revision arthroscopic surgery and three cases (1.6%) were converted to total hip arthroplasty.CONCLUSION: Patients with early-stage osteoarthritis of various diagnoses achieved improved clinical outcomes. Therefore, using hip arthroscopy in middle-aged patients with early osteoarthritis, it is possible to achieve good surgical options.

Arthroplasty, Replacement, Hip , Arthroscopy , Diagnosis , Follow-Up Studies , Hip , Humans , Middle Aged , Osteoarthritis , Retrospective Studies
Hip & Pelvis ; : 35-41, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811156


PURPOSE: Arthroscopy for repair of femoroacetabular impingement (FAI) and related conditions is technically challenging, but remains the preferred approach for management of these hip pathologies. The incidence of this procedure has increased steadily for the past few years, but little is known about its potential long-term effects on future interventions. The purpose of this study was to evaluate whether prior arthroscopic correction of FAI pathology impacts postoperative complication rates in patients receiving subsequent ipsilateral total hip arthroplasty (THA) on a national scale.MATERIALS AND METHODS: A commercially available national database – PearlDiver Patients Records Database – identified primary THA patients from 2005 to 2014. Patients who had prior arthroscopic FAI repair (post arthroscopy group) were separated from those who did not (native hip group). Prior FAI repair was examined as a risk factor for complications following THA and a multivariable logistic regression analysis was applied to identify risk factors for complications following THA.RESULTS: A total of 11,061 patients met all inclusion and exclusion criteria; 10,951 in the native hip group and 110 in the post arthroscopy group. Prior FAI repair was not significantly associated with higher rates of 90-day readmission (P=0.585), aseptic dislocation/revision within 3 years (P=0.409), surgical site infection within 3 years (P=0.796), or hip stiffness within 3 years (P=0.977) after THA.CONCLUSION: Arthroscopic FAI repair is not an independent risk factor for complications following subsequent ipsilateral THA (level of evidence: III).

Arthroplasty, Replacement, Hip , Arthroscopy , Femoracetabular Impingement , Hip , Humans , Incidence , Logistic Models , Pathology , Postoperative Complications , Risk Factors , Surgical Wound Infection
Article in English | WPRIM (Western Pacific) | ID: wprim-811125


BACKGROUND: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.METHODS: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.RESULTS: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all p < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all p < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).CONCLUSIONS: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.

Acute Kidney Injury , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Comorbidity , Female , Hematoma , Hip Dislocation , Hip , Humans , Inpatients , Knee , Length of Stay , Logistic Models , Lupus Erythematosus, Systemic , Myocardial Infarction , Pneumonia , Pulmonary Embolism , Risk Factors , Seroma , Stroke , Venous Thrombosis , Wound Infection , Wounds and Injuries
rev. cuid. (Bucaramanga. 2010) ; 10(2): e651, mayo-ago. 2019. tab
Article in Portuguese | LILACS (Americas), BDENF, COLNAL | ID: biblio-1059197


Resumo Introdução A Artroplastia Total de Quadril se apresenta como um procedimento eficaz para a diminuição da dor em articulações e para a melhora funcional das pessoas. Objetivo Selecionar resultados e indicadores da Nursing Outcomes Classification (NOC) e construir definições conceituais e operacionais, para avaliação da dor de pacientes após Artroplastia Total de Quadril. Materiais e Métodos Estudo de consenso entre especialistas. As definições foram construídas baseadas na literatura e experiência dos autores. Estabeleceu-se um consenso de 100% para o conteúdo do instrumento das definições conceituais e operacionais do resultado de enfermagem. Resultados Foi selecionado o resultado de enfermagem Nível de dor, com onze indicadores, a mencionar: Dor relatada, Duração dos episódios de dor, Expressões faciais de dor, Agitação, Irritabilidade, Encolhimento, Diaforese, Náusea, Frequência respiratória, Frequência do pulso radial e Pressão arterial. Cada um dos onze indicadores foi definido conceitual e operacionalmente. Discussão e Conclusões A seleção desse resultado e de seus indicadores, assim como a construção das definições podem favorecer a aplicação da NOC com maior fidedignidade nessa população, além de aprimorar a assistência e contribuir no aperfeiçoamento da classificação.

Abstract Introduction Total Hip Arthroplasty (THA) is an effective procedure to relieve joint pain and to provide functional improvement in patients. Objective Based on the outcomes and indicators from the Nursing Outcomes Classification (NOC), this study aims to create conceptual and operational definitions to assess pain in patients undergoing Total Hip Arthroplasty. Materials and Methods Consensus study among experts. Definitions were based on literature review and author experience. Complete agreement was found on instrument content in relation to the conceptual and operational definitions from nursing outcomes. Results The nursing outcome 'pain level' was selected which had eleven indicators, being notable the self-reported pain, duration of pain episodes, facial expressions of pain, agitation, irritability, muscle contraction, diaphoresis, nausea, respiratory rate, heart rate at the radial point and blood pressure. Discussion and conclusions The selection of this outcome and its indicators as well as the creation of definitions might benefit the NOC application in a more reliable manner over that population, apart from improving assistance and helping adjust this classification.

Resumen Introducción La Artroplastia Total de Cadera se presenta como un procedimiento eficaz para disminuir el dolor en las articulaciones y para alcanzar la mejora funcional de las personas. Objetivo Seleccionar resultados e indicadores de la Nursing Outcomes Classification (NOC) y construir definiciones conceptuales y operacionales para la valoración del dolor de los pacientes que son sometidos a una Artroplastia Total de Cadera. Materiales y Métodos Estudio de consenso entre especialistas. Las definiciones se construyeron con base en la literatura y en la experiencia de los autores. Se estableció un consenso de 100% para el contenido del instrumento con respecto a las definiciones conceptuales y operacionales del resultado de la enfermería. Resultados Se escogió el resultado de enfermería Nivel de dolor, con once indicadores, de los cuales vale la pena destacar: Dolor reportado, Duración de los episodios de dolor, Expresiones faciales de dolor, Agitación, Irritabilidad, Encogimiento, Diaforesis, Náuseas, Frecuencia respiratoria, Frecuencia del pulso radial y Presión arterial. Cada uno de los once indicadores se definió conceptual y operativamente. Discusión y Conclusiones La selección de este resultado y de sus indicadores, así como la construcción de las definiciones pueden favorecer la aplicación de la NOC de manera más fidedigna en esa población, además de mejorar la asistencia y contribuir a perfeccionar la clasificación.

Humans , Male , Female , Pain Measurement , Arthroplasty, Replacement, Hip , Consensus , Standardized Nursing Terminology
Rev. bras. ortop ; 54(4): 459-464, July-Aug. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1042418


Abstract Objective The purpose of the present study was to evaluate retrospectively the clinical and radiographic results of total hip arthroplasty (THA) performed with the Exeter technique and using the Exeter prosthesis. Methods Between March 2000 and December 2006, 504 THAs were performed in 477 patients, with several etiological diagnoses. A total of 260 surgeries were performed on the right side, 244 on the left side, and 27 were performed bilaterally. The mean age of the patients was 58.9 (17.7-86.8) years old, with a median of 69.0 years old. The preoperative planning was performed with appropriate templates. All of the surgeries were performed through the posterolateral approach with the patient placed on lateral decubitus. The clinical evaluation was performed according to the Harris hip score (HHS). In the radiographic evaluation, the bone cement interface in the three zones of DeLee and Charnley on the acetabular side and in the seven zones of Gruen on the femoral side were studied. Subsidence of the femoral component, presence of diaphyseal hyperthrophy, and heterotopic ossification were also observed. Results The mean follow-up of 441 surgeries (87.5%) was of 7.2 (1.0-16.6) years, with a median of 7.1 years. The incidence of complications was: dislocation, 3.2%; infection, 2.2%; peripheral nerve disorders 2.0%; thromboembolism 2.7%, acetabular cup loosing 2.0%; diaphyseal hypertrophy, 1.26%; distal migration of the femoral component between 2,0 mm and 2.9 mm, 0.5%; 1 case of aseptic loosing of the femoral component and 9 (1.8%) of the acetabular component. The mean HHS was mean 92.3 (50-100) points. Conclusion Cemented THA, with themethodology applied, proved to be an effective treatment for this group of patients. The results were satisfactory with acceptable complication rates.

Resumo Objetivo Avaliar os resultados da artroplastia total do quadril (ATQ) cimentada, coma utilização da técnica e prótese da escola Exeter. Metódo Entre março de 2000 e dezembro de 2006, foram realizadas 504 ATQs em 477 pacientes, com diversos diagnósticos etiológicos, 260 à direita e 244 à esquerda, 27 bilaterais,. A idade média foi de 58,9 (17,7-86,8) anos, com mediana de 69,0 anos. O planejamento radiográfico foi feito utilizando-se gabaritos apropriados. O acesso cirúrgico foi o posterolateral com o paciente em decúbito lateral. Para a avaliação clínica, foi utilizado o escore do quadril de Harris (EQH). Na avaliação radiográfica, foi estudada a interface osso-cimento acetabular, nas três zonas de DeLee e Charnley e nas sete zonas de Gruen do lado femoral, a presença de migração distal do componente femoral, hipertrofia diafisária, e ossificação heterotópica. Resultados O seguimento médio de 441 cirurgias (87,5%) foi de 7,2 (1,0-16,6) anos, com mediana de 7,1 anos. A incidência de complicações foi: luxação, 3,2%; infecção ,2,2%; tromboembolismo, 2,1%; disfunção de nervos periféricos 1,1%; hipertrofia diafisária, 1,5%; soltura do componente acetabular, 1,8%; migração distal do componente femoral entre 2,0mm e 2,9 mm, 0,45%; 1 caso de soltura asséptica do componente femoral; e 1 caso de fratura da haste femoral. A pontuação média com o EQH foi de 92 pontos. Conclusão A ATQ cimentada, com a metodologia utilizada, constituiu-se em uma opção eficaz para o tratamento deste grupo de pacientes, comresultados satisfatórios, com este tempo de seguimento.

Humans , Male , Female , Middle Aged , Aged , Bone Cements , Osteoarthritis, Hip , Arthroplasty, Replacement, Hip , Hip Joint , Hip Prosthesis
Rev. bras. ortop ; 54(4): 453-458, July-Aug. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1042422


Abstract Objective The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs). Methods A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause. Results Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated. Conclusions In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.

Resumo Objetivo Avaliar os resultados clínicos e radiográficos da haste femoral não cimentada Logical (Baumer, Mogi Mirim, SP, Brasil) nas artroplastias totais do quadril (ATQs). Método Foi realizada uma coorte retrospectiva de 632 pacientes submetidos à artroplastia primária do quadril por coxartrose nos quais foram implantadas hastes femorais não cimentadas Logical. Todos os pacientes eram provenientes do ambulatório de Cirurgia do Quadril da instituição. O período do estudo compreendeu de janeiro de 2004 a janeiro de 2015. O desfecho definido para avaliar a sobrevida da haste foi a indicação clínica e radiográfica da revisão ou a revisão propriamente dita da haste femoral por qualquer causa. Resultado Observaram-se curvas de sobrevida estimadas > 95%, com um seguimento variando de 2 até 13 anos. Houve baixa incidência de fraturas periprotéticas transoperatórias (0,02%). Não foi observada migração axial ou atrofia óssea cortical na amostra radiográfica avaliada. Conclusão Os resultados demonstram, nomédio prazo, excelente sobrevida da haste femoral não cimentada Logical. Embora ainda sejam aguardados estudos no longo prazo, este implante parece ser seguro e promissor para ser utilizado nas artroplastias primárias do quadril.

Humans , Male , Female , Child, Preschool , Child , Bone Cements , Follow-Up Studies , Arthroplasty, Replacement, Hip , Hip Joint
Rev. bras. ortop ; 54(4): 447-452, July-Aug. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1042425


Abstract Objective To determine if the dimensions of selected national and imported implants used in total hip arthroplasty surgeries are adequate regarding the anthropometric profile of the Brazilian population. Methods A retrospective study of patients submitted to primary total hip arthroplasty. Patients with femoral or acetabular morphological deformities that could influence the choice of implant size, including dysplasia and previous fractures, were excluded from the study. Two national implants and six imported implants were included in the study. Every patient was treated by the same group, with one of the four senior authors or under their strict supervision, following the same surgical technique. The datawere analyzed regarding gender, age, fixation type and implant model. Results The analysis of 682 hips submitted to total hip arthroplasty demonstrated that 2 models of cemented femoral stems and 1 of non-cemented stem did not seem to be perfectly adequate for the femoral morphology of the studied population, since these 3 implants were mostly used in the smallest size available, resulting in a non-Gaussian curve. The mean diameter of the native acetabulum was 54mm in men and 52mm in women. Conclusion Out of the eight models studied, five were deemed adequate for the studied population. The other three models available in our market (two national models and one imported model) apparently require more appropriate sizing. We emphasize that anthropometric studies of the Brazilian hip are necessary to give scientific subsidies to the ideal implant design for our market.

Resumo Objetivo Definir se as dimensões de alguns implantes de fabricação nacional e estrangeira utilizados nas cirurgias de artroplastia do quadril estão adequadas ao perfil antropométrico da população brasileira. Métodos Estudo retrospectivo de pacientes submetidos a cirurgia primária de substituição artroplástica total do quadril. Foram excluídos deste estudo pacientes comalterações morfológicas femorais ou acetabulares que pudessem influenciar na escolha do tamanho dos implantes, tais comosequelas de displasia, trauma, entre outras. Foramincluídos neste estudo dois implantes de fabricação nacional e seis modelos importados. Todos os pacientes foram operados pela mesma equipe, por um dos quatro autores seniores ou sob sua supervisão direta, seguindo a mesma técnica cirúrgica. Os dados foram estatisticamente analisados em relação a gênero, idade, tipo de fixação e modelo dos implantes. Resultados A análise estatística de 682 quadris submetidos a artroplastia total demonstrou que 2 modelos de hastes femorais cimentadas e 1 de haste não cimentada não estão perfeitamente adequados à morfologia femoral da população estudada, pois, na maioria dos casos, nestes 3 implantes, foi utilizado o menor tamanho disponível, resultando em uma curva não gaussiana. O diâmetro médio do acetábulo nativo foi de 54mm nos homens e de 52mm nas mulheres. Conclusão Dos oitomodelos estudados, cinco semostraram adequados à população estudada. Outros três modelos disponíveis em nosso mercado (dois nacionais e um importado) parecem necessitar de um escalonamento mais adequado. Destacamos que são necessários estudos antropométricos do quadril da população brasileira para dar subsídios científicos ao desenho ideal dos implantes para o nosso mercado.

Humans , Male , Female , Prosthesis Design , Arthroplasty, Replacement, Hip , Hip Fractures , Hip Prosthesis
Rev. bras. ortop ; 54(4): 465-470, July-Aug. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1042426


Abstract Objective The aim of the present study is to investigate the biomechanical stability of different subtrochanteric osteotomy types and graft positions in cases of dysplastic coxarthrosis that require total hip arthroplasty with shortening osteotomy, as well as to find out the most effective osteotomy type and graft position. Method Femur sawbones were used to compare different types of femoral shortening osteotomy (transverse, oblique, and step-cut). Strut grafts, which were prepared at the side of the subtrochanteric shortening osteotomy, were fixed in different positions (anterolateral, mediolateral, and anteroposterior). The fixation of the strut grafts was performed using two steel cables (with 2.0mm of thickness) with the same strength. The failure values of composite femurs were recorded for axial and rotational loadings. Results Biomechanically, there were no statistically significant differences between the types of femoral subtrochanteric shortening osteotomy and the positions of the applied strut graft. Conclusion No superiority was observed between the types of femoral subtrochanteric shortening osteotomy regarding stability. Additionally, against stress, similar results were obtained for different strut graft positions. In conclusion, we believe that using the method in which the surgeon is experienced and that is the easiest to apply would be the best choice.

Resumo Objetivo O objetivo do presente estudo é investigar a estabilidade biomecânica de diferentes tipos de osteotomias subtrocantéricas e posições de enxertos em coxartroses displásicas que necessitam de artroplastia total de quadril com osteotomia de encurtamento, e determinar o tipo de osteotomia e a posição do enxerto que são mais eficazes. Método Modelos de fêmur (sawbones) foram usados para comparar os tipos de osteotomia de encurtamento femoral (transversal, oblíqua e emdegrau de escada [step-cut]). Os enxertos em haste, preparados do lado da osteotomia subtrocantérica, foram fixados em diferentes posições (ântero-lateral, medial-lateral e ântero-posterior). A fixação dos enxertos foi feita com2 cabos de aço (de 2,0mmde largura) de mesmaresistência.Os valores de falha dos fêmures compostos para cargas axiais e rotacionais foram registrados. Resultados Do ponto de vista biomecânico, não houve diferenças estatisticamente significativas entre os tipos de osteotomia de encurtamento subtrocantérico femoral e as posições dos enxertos em haste aplicados. Conclusão Não houve superioridade entre os tipos de osteotomia de encurtamento subtrocantérico femoral quanto à estabilidade. Além disso, em relação à resistência ao estresse, os resultados obtidos com diferentes posições das hastes foram similares. Assim, acreditamos que o método mais indicado é aquele em que o cirurgião é experiente e cuja aplicação é mais fácil.

Osteotomy , Osteoarthritis, Hip , Bone Transplantation , Arthroplasty, Replacement, Hip , Hip Dislocation
Rev. bras. ortop ; 54(4): 471-476, July-Aug. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1042434


Abstract Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hipwere evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with amean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant (p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant (p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril comuso de tântalo entre o período de junho de 2013 e abril de 2017. Foramavaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componenteao centro de rotação anatômicodoquadril.Asmedidas foramrealizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pósoperatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p < 0,001). Conclusão As revisões de artroplastia do quadril comcopas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.

Humans , Male , Female , Middle Aged , Aged , Tantalum , Arthroplasty, Replacement, Hip , Acetabulum
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 112-121, jun. 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1003019


Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura periprotésica intraoperatoria con un tallo corto tipo 2B de fijación cervicometafisaria. Materiales y Métodos: Se analizaron prospectivamente los primeros 100 tallos (84 pacientes) MiniHipTM (Corin, Cirencester, Reino Unido) colocados, en forma consecutiva, por un mismo cirujano. La edad promedio fue de 47 años. La indicación para un tallo corto fue: edad <55 años (85 casos) o la participación previa en deportes de impacto en pacientes de entre 56 y 60 años (15 casos). El diagnóstico inicial fue artrosis primaria de cadera en el 82% de los casos. El seguimiento promedio fue de 42 meses. Resultados: El puntaje en la escala de Harris modificada mejoró de 55 a 96 al final del seguimiento (p = 0,02) y ningún paciente refirió dolor de muslo en el posoperatorio. La supervivencia del tallo fue del 99% (IC95% 93,1-99,8). Un caso presentó una perforación de la cortical lateral intraoperatoria, tratado con revisión con un tallo no cementado convencional. Un paciente tuvo una infección aguda, que fue tratada con desbridamiento, retención de componentes y antibióticos, con resultado favorable a los 48 meses de la cirugía. Se produjeron 3 fracturas incompletas del calcar intraoperatorias (3%). Conclusiones: Se obtuvieron resultados excelentes en esta serie de pacientes jóvenes y activos operados por un mismo cirujano con un tallo corto tipo 2B, a los 2-5 años de seguimiento, con un 1% de falla por falsa vía femoral intraoperatoria. Nivel de Evidencia: IV

Objective: We aimed to determine 2- to 5-year survivorship rate, intraoperative fractures, subsidence and thigh pain rate in a consecutive, independent, one-surgeon series of surgical patients in whom a type 2B short stem was implanted. Methods: We reviewed the first 100 type 2B consecutive femoral short stems implanted in 84 patients with a mean age of 47 years old. Indications included age younger than 55 years (85 hips), or participation in impact sports in patients aging 56 to 60 years old (15 hips). Initial diagnosis was osteoarthritis in 82% of the cases. Median follow-up was 42 months. Results: Stem survivorship rate was 99% at 2 to 5 years followed by stem revision for any aseptic reason, and 98% when infection played a part. Mean Harris Hip Score improved significantly from 55 to 96 at final follow-up (p 0.02). There was one lateral cortex perforation, and three intra-operative calcar partial fractures (3%), only one of them required cerclage wiring and delayed weight-bearing. No patient referred thigh pain at final follow-up. Only one case subsided 4 mm, but then stabilized. The risk of revision was 1% after 2 to 5 years (95%CI 93.1-99.8%). Conclusions: We obtained promising short-term results with this device in this single-surgeon, non-consecutive series -including the learning curve period- using a type 2B short stem in young active patients-, in which bone preservation is warranted. Level of Evidence: IV

Adult , Middle Aged , Osteoarthritis, Hip/surgery , Arthroplasty, Replacement, Hip , Hip Joint/surgery , Prospective Studies , Follow-Up Studies , Treatment Outcome
Rev. cuba. ortop. traumatol ; 33(1)ene.-jun. 2019. graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1101658


Introducción: La restauración de las fuerzas biomecánicas a través del ajuste del offset y la longitud de miembros se ha convertido en un objetivo importante cuando el cirujano busca un buen resultado funcional postoperatorio. Sin embargo, las ventajas clínicas de la restauración del offset femoral y las complicaciones del fallo en la restauración no han sido claramente establecidas. Objetivo: Evaluar el efecto del offset o voladizo femoral en los resultados clínicos y funcionales de los pacientes. Adquisición de la evidencia: Se realizó una exploración en la base de datos Pubmed, con las palabras clave: artroplastia de cadera, prótesis de cadera, resultado clínico y resultado funcional.Se buscaron artículos publicados entre 2008 y 2018, basados en humanos y escritos en inglés, español o francés. Se seleccionaron seis artículos que incluían la presencia de una medición radiológica del offset femoral claramente explicada, escalas validadas y análisis comparativo. Resultados: La literatura consultada reflejó resultados heterogéneos. En el grupo de pacientes con offset disminuido, un artículo mostró menos función. En otro estudio se observó mejor puntuación en el grupo de enfermos con offset aumentado. A su vez, en una investigación se comprobó menos dolor en el grupo de offset disminuido. Conclusiones: Debido a la inconsistencia en los resultados y en las metodologías empleadas, no ha sido posible reconocer el beneficio clínico y funcional de la restauración del offset. Algunos autores incluidos en esta revisión, después de no encontrar diferencias estadísticamente significativas, afirmaron que la restauración o el aumento del offset femoral aportó buenos resultados, sin efectos negativos(AU)

Introduction: The restoration of biomechanical forces through offset adjustment and limb length has become an important objective when the surgeon seeks a good postoperative functional result. However, the clinical advantages of femoral offset restoration and complications of restoration failure have not been clearly established. Objective: To evaluate the effect of offset or femoral cantilever on the clinical and functional results of the patients. Acquisition of evidence: An exploration was carried out in the Pubmed database, with the keywords: hip arthroplasty, hip prosthesis, clinical result and functional result. We searched for articles published from 2008 to 2018, based on humans and written in English, Spanish or French. Six articles were selected because they clearly explained the presence of a radiological measurement of the femoral offset, including validated scales and comparative analysis. Results: The literature consulted reflected heterogeneous results. In the group of patients with decreased offset, one article showed less function. In another study, a better score was observed in the group of patients with increased offset. In turn, one investigation reported less pain was found in the reduced offset group. Conclusions: Due to the inconsistency in the results and the methodologies used, it has not been possible to recognize the clinical and functional benefit of offset restoration. Some authors included in this review, after not finding statistically significant differences, stated that the restoration or increase of the femoral offset provided good results, without negative effects(AU)

Introduction: La restauration des forces biomécaniques par ajustement du déport et la longueur des membres est devenue un objectif important lorsque le chirurgien cherche un bon résultat fonctionnel postopératoire. Cependant, les bénéfices cliniques de la restauration du déport fémoral et les complications dues aux troubles de cette restauration n'ont pas été clairement définis. Objectif: Évaluer l'effet du déport fémoral (offset) sur les résultats cliniques et fonctionnels des patients. Acquisition des données: Une exploration a été effectuée dans la base de données PubMed, en utilisant les mots clés artroplastia de cadera, prótesis de cadera, resultado clínico et resultado funcional. On a cherché des articles publiés entre 2008 et 2018, basés sur des études chez les humains et écrits en anglais, espagnol ou français. Six articles comprenant la présence d'une mesure radiologique du déport fémoral clairement expliquée, des échelles validées et une analyse comparative ont été sélectionnés. Résultats: La littérature consultée a montré des résultats hétérogènes. Un article a mis en évidence une faible fonction dans un groupe de patients ayant un déport diminué. Dans une autre étude, on a trouvé une meilleure ponctuation dans un groupe de malades ayant un déport augmenté. Au même temps, on a pu constater dans une recherche qu'il y a eu moins douleur dans un groupe ayant un déport diminué. Conclusions: Due à l'inconsistance des résultats et des méthodologies employées, il a été impossible de démontrer le bénéfice clinique et fonctionnel de la restauration du déport. Malgré l'impossibilité de trouver de différences statistiquement significatives, quelques auteurs inclus dans cette revue de littérature ont affirmé que la restauration ou augmentation du déport fémoral a donné de bons résultats, sans effets indésirables(AU)

Arthroplasty, Replacement, Hip/instrumentation , Spain
An. bras. dermatol ; 94(3): 363-364, May-June 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1011113


Abstract: The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Humans , Male , Middle Aged , Suppuration/diagnosis , Arthroplasty, Replacement, Hip/adverse effects , Hip Prosthesis/adverse effects , Streptococcus agalactiae/isolation & purification , Suppuration/microbiology , Thigh , Biopsy , Tomography, X-Ray Computed , Femur
Rev. bras. ortop ; 54(2): 206-209, Mar.-Apr. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1013703


Abstract The authors report a single case of complex primary hip total arthroplasty in a 34-yearold female patient with a 5.5 cm lower limb dysmetria, in whom a maximum gluteus tenotomy was performed in order to prevent sciatic nerve injury. The surgery was performed under electroneurophysiological monitoring of the fibular and tibial branches of the sciatic nerve, collecting pretenotomy, posttenotomy, and postarthroplasty reduction data. The findings demonstrate that the maximum gluteus tenotomy improved the motor response of the fibular component of the sciatic nerve.

Resumo Os autores relatam um único caso de artroplastia total de quadril primária complexa em uma paciente do sexo feminino de 34 anos, com dismetria de membros inferiores de 5,5 cm, na qual foi feita tenotomia do glúteo máximo a fim de prevenir lesão do nervo ciático. Tal cirurgia foi feita sob monitoração eletroneurofisiológica dos ramos fibular e tibial do nervo ciático. Foramcoletados dados pré-tenotomia, pós-tenotomia e pós-redução artroplástica. Os achados demonstram que a tenotomia do glúteo máximo melhorou a reposta motora do componente fibular do nervo ciático.

Humans , Female , Adult , Sciatic Nerve/injuries , Arthroplasty, Replacement, Hip , Tenotomy/methods
Rev. bras. ortop ; 54(1): 87-89, Jan.-Feb. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1003597


Abstract The authors describe a case of a large diameter head metal-on-metal total hip replacement that evolved with an inflammatory pseudotumor formation. The diagnosis was established bymagnetic resonance imaging (MRI) with suppression of themetal artifact. The treatment consisted on the resection of the abnormal tissue and on the revision to a ceramic on cross-linked polyethylene hip replacement. To this date, no similar case has been reported, in Portuguese language, in the PubMed, Scielo, and Lilacs databases.

Resumo Os autores descrevem caso de artroplastia total do quadril (ATQ) com par tribológico metal-metal e cabeça de grande diâmetro que evoluiu com formação de pseudotumor inflamatório. O diagnóstico foi estabelecido por ressonânciamagnética comsupressão de artefato metálico. O tratamento consistiu na ressecção do tecido anormal e revisão com par tribológico cerâmica-polietileno reticulado. Nenhum caso semelhante em língua portuguesa encontra-se descrito nas bases de dados PubMed, Scielo e Lilacs até a presente data.

Humans , Male , Middle Aged , Arthroplasty, Replacement, Hip , Granuloma, Plasma Cell
Belo Horizonte; s.n; 2019. 89 p. graf, tab, ilus.
Thesis in Portuguese | LILACS (Americas), BDENF | ID: biblio-1010265


As cirurgias ortopédicas com uso de prótese são procedimentos utilizados para o tratamento de doenças em articulações. Embora seja um procedimento bastante utilizado, o paciente está sujeito as várias complicações e insucesso do tratamento. Entre essas complicações, a infecção de sítio cirúrgico (ISC) é uma das mais prevalentes, com incidências variando entre 1,4% e 12,6%. Para prevenir essa afecção, o acompanhamento da incidência e a monitorização de fatores de risco permitirão adoções de práticas de prevenção baseadas em evidências, visando uma assistência mais segura. Este estudo é uma coorte não concorrente de 149 pacientes submetidos à artroplastia total de quadril (ATQ) e artroplastia total de joelho (ATJ). O objetivo geral foi analisar os aspectos epidemiológicos das infecções de sitio cirúrgico nos pacientes submetidos à cirurgia ortopédica, no período de 2015 a 2018 em um hospital de grande porte de Belo Horizonte, Minas Gerais. Os objetivos específicos foram estimar a incidência das infecções de sítio cirúrgico; estimar a incidência de infecção de sítio cirúrgico (ISC) por topografia; identificar os fatores de risco associados à infecção ortopédica; identificar os microorganismos responsáveis pelas infecções e propor modelo preditivo multivariado. Na análise univariada, aplicou-se o teste não paramétrico de Mann Whitney. E para verificar a hipótese de associação entre as variáveis categóricas com os grupos, aplicouse o teste exato de Fisher. Na análise multivariada, aplicou-se o modelo de Regressão Logística (p-valor<0,05.) Foram notificadas seis ISC, com taxa global de 4,03%, todas caracterizadas como superficiais. Nos pacientes que foram submetidos à ATJ, a incidência de ISC foi de 2,94% e os que realizaram ATQ, 4,94%. Os fatores de risco identificados para ISC ortopédicas foram idade e hipertensão arterial sistêmica. Os microorganismos isolados foram Enterobacter cloacae, Acinetobacter baumannii e Stenotrophomonas maltophilia. As taxas de ISC encontradas neste estudo foram maiores que as recomendadas pelo NHSN/CDC.(AU)

Orthopedic surgeries with prosthesis are procedures used for the treatment of diseases in joints. Although it is a widely used procedure, the patient is subject to various complications and treatment failure. Among these complications, surgical site infection (SSI) is one of the most common, with incidence varying between 1.4% and 12.6%. To prevent this condition, monitoring incidence and monitoring risk factors will allow adoptions of evidencebased prevention practices for safer care. This study is a non-concurrent cohort of 149 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The general objective was to analyze the epidemiological aspects of surgical site infections in patients submitted to orthopedic surgery from 2015 to 2018 at a large hospital in Belo Horizonte, Minas Gerais. The specific objectives were to estimate the incidence of surgical site infections; to estimate the incidence of surgical site infection (SSI) by topography; identify the risk factors associated with orthopedic infection; identify the microorganisms responsible for infections and propose a multivariate predictive model. In the univariate analysis, the nonparametric Mann Whitney test was applied. And to verify the hypothesis of association between the categorical variables with the groups, Fisher's exact test was applied. In the multivariate analysis, the Logistic Regression model was applied (p-value <0.05). Six SSIs were reported, with an overall rate of 4.03%, all characterized as superficial. In patients who underwent TKA, the incidence of SSI was 2.94% and those who undergoing TKA, 4.94%. The risk factors identified for orthopedic SSIs were age and systemic arterial hypertension. The isolated microorganisms were Enterobacter cloacae, Acinetobacter baumannii and Stenotrophomonas maltophilia. The SSI rates found in this study were higher than those recommended by the NHSN / CDC.(AU)

Humans , Male , Female , Middle Aged , Surgical Wound Infection/epidemiology , Risk Factors , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Prostheses and Implants/adverse effects , Surveys and Questionnaires , Retrospective Studies , Enterobacter cloacae , Academic Dissertation , Stenotrophomonas maltophilia , Acinetobacter baumannii
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-781680


OBJECTIVE@#To analyze the level of serum N-terminal propeptide of type I precollagen (PINP) and tartrate resistant acid phosphatase 5b(TRACP-5b) in patients with femoral neck fracture(FNF) after minimally invasive anterior lateral approach with total hip arthroplasty and the effects of hip function.@*METHODS@#From September 2016 to May 2017, 98 cases of femoral neck fracture were divided into control group and observation group, 49 cases in each group. There were 49 patients in control group, including 30 males and 19 females, ranging in age from 63 to 72 years old, who underwent minimally invasive anterolateral total hip arthroplasty. There were 49 patients in observation group, including 29 males and 20 females, ranging in age from 62 to 73 years old, who underwent minimally invasive anterolateral total hip arthroplasty. The perioperative conditions(operation time, bleeding volume, incision length, hospitalization time), bone metabolism indexes including PINP, TRACP-5b, fibroblast growth factor(FGF), bone gla-protein(BGP), propetide carboxy-terminal procollagen (PICP), bone-specific alkaline phosphatase(BAP), and pain mediators such as prostaglandin E2 (PGE2) and 5-hydroxytrytamine (5-HT) levels were compared between the two groups. The hip joint function and complications were evaluated.@*RESULTS@#The operation time of the observation group was longer than that of the control group(0.05). PINP, fibroblast growth factor, BGP, PICP and BAP in observation group were higher than those in control group 1 month after operation, and TRACP-5b was lower than those in control group(0.05).@*CONCLUSIONS@#Minimally invasive anterolateral approach total hip arthroplasty is safe and reliable, and can improve hip function, improve bone metabolism, promote fracture healing, alleviate pain in patients with femoral neck fracture, which is worthy of promotion.

Aged , Arthroplasty, Replacement, Hip , Collagen Type I , Female , Femoral Neck Fractures , General Surgery , Hip Joint , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Tartrate-Resistant Acid Phosphatase , Treatment Outcome
Article in Korean | WPRIM (Western Pacific) | ID: wprim-766415


The incidence of acetabular fractures in the elderly has increased because of the increasing elderly population. To determine the treatment plan for acetabular fractures, the patient's age, gait ability, presence or absence of osteoporosis and osteoarthritis, underlying disease, and fracture pattern should be considered. The application of total hip arthroplasty for acetabular fractures with the proper indications can be expected to have a good prognosis. In this paper, the application of total hip arthroplasty as a treatment method for acetabular fractures is divided into acute and delayed phases.

Acetabulum , Aged , Arthroplasty , Arthroplasty, Replacement, Hip , Gait , Hip , Humans , Incidence , Methods , Osteoarthritis , Osteoporosis , Prognosis
Hip & Pelvis ; : 179-189, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-763986


In the 1960s, Sir John Charnley introduced to clinical practice his concept of low-friction total hip arthroplasty (THA). Although early designs were plagued by poor performance and even failure, there have been steady advances in implant designs, biomaterials, surgical techniques and an understanding of the biomechanical restoration of the hip; these advances have contributed to improvements in implant survival and clinical outcomes of THA in the past three decades. With improved wear resistance and mechanical reliability, a potential to last for at least 25 to 30 years are now available for THA. In this review, we focus on the evolution of THA and review current controversies and future directions of this procedure based on a single surgeon's 29-year of experience at a single institution.

Arthroplasty, Replacement, Hip , Biocompatible Materials , Hip
Hip & Pelvis ; : 224-231, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-763981


PURPOSE: A retrospective analysis of mid- to long-term clinical and radiological outcomes of Korean patients over 60 years of age who underwent hip arthroplasty using a cementless rectangular tapered stem according to Dorr proximal femur geography. MATERIALS AND METHODS: From January 2007 to December 2013, 107 patients (112 hips) underwent hip arthroplasty using the C2 stem. The mean age of patients was 77.4 years (range, 60–91 years) and the mean follow-up duration was 91.1 months (range, 60–116 months). All patients were evaluated clinically and radiologically with special attention to Dorr femoral bone classification, implant fixation, radiolucent line (RLL), and thigh pain. RESULTS: All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. The mean Harris hip score improved from 65.5±16.0 (preoperative) to 90.5±15.9 (final follow-up) (P<0.001). Incidence of RLLs, stress shielding, and thigh pain was highest in patients with Dorr type A (RLL, P=0.021; stress shielding, P=0.030; thigh pain, P<0.001). One stem revision was performed due to deep infection. The Kaplan–Meier survival rate of the femoral stem was 97.6%. CONCLUSION: The overall survival rate of the C2 stems was greater than 97%; there were no significant differences in survival of the C2 stem according to the Dorr classification. The incidences of RLL of thigh pain and RLL were significantly different among Dorr classifications and (highest in patients with Dorr type A).

Aged , Arthroplasty , Arthroplasty, Replacement, Hip , Asian Continental Ancestry Group , Classification , Femur , Follow-Up Studies , Geography , Hip , Humans , Incidence , Retrospective Studies , Survival Rate , Thigh
Hip & Pelvis ; : 232-237, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-763980


PURPOSE: In patients with independent mobility, full hip range of motion and sufficient muscle strength for daily life without cognitive impairment, treatment of a femoral neck fracture with total hip arthroplasty (THA) may be a better option compared to bipolar hip hemiarthroplasty. Here, functional outcomes and complications in patients who underwent THA for femoral neck fracture based on their comorbidity status were analyzed. MATERIALS AND METHODS: Between January 2013 and December 2018, 110 patients were treated with THA for femoral neck fractures at our institution. These patients were retrospectively analyzed for clinical outcomes at final follow-up (mean=24.4 months, range: 6–81 months) using the Harris hip score (HHS) and the presence or absence of two potential comorbidities: i) diabetes mellitus (DM; 35 with and 75 without) and ii) hypertension (HTN; 50 with and 60 without). RESULTS: The incidence of superficial infections at the surgical site in patients with DM was significantly higher compared with patients without DM (P=0.024). There were no significant differences in other potential complications based on DM status. HHS at final follow-up between patients with and without DM and with and without HTN were not significantly different (83.3 vs. 81.0, P=0.39 and 81.6 vs. 82.4, P=0.75, respectively). CONCLUSION: Superficial infections occurred more frequently in patients with DM compared with patients without DM. DM and HTN status are not correlated with HHS.

Arthroplasty, Replacement, Hip , Cognition Disorders , Comorbidity , Diabetes Mellitus , Femoral Neck Fractures , Femur Neck , Follow-Up Studies , Hemiarthroplasty , Hip , Humans , Hypertension , Incidence , Muscle Strength , Range of Motion, Articular , Retrospective Studies