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Article in English | WPRIM | ID: wpr-928476


Prosthetic infection is one of the severe postoperative complications of arthroplasty. Mixed bacterial-fungal prosthetic infection is rare but can be disastrous. This case was a 76-year-old female suffered from prosthetic infection following total hip replacement due to femoral neck fracture and underwent multiple debridements. The culture of periprosthetic tissue was bacteriologically sterile following the first debridement, while the Staphylococcus hominis was identified in the second debridement in the previous hospitalization where fungal infection had not been considered. Thus the pathogen spectrum of anti-infection therapy failed to contain fungus. Ultimately, the culture result of our sampled periprosthetic tissue during the third debridement was Candida albicans without bacterium in our hospital. The fungal prosthetic infection was successfully treated by a two-stage revision with antifungal drugs. Accurate diagnosis and standardized treatment is the key to the therapy of infection after hip arthroplasty, especially for mixed bacterial-fungal prosthetic infection.

Aged , Anti-Bacterial Agents/therapeutic use , Arthroplasty, Replacement, Hip/adverse effects , Debridement , Female , Fungi , Hip Prosthesis/adverse effects , Humans , Mycoses/drug therapy , Prosthesis-Related Infections/therapy , Reoperation , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928274


The choice of friction interface has always been a controversial topic in hip arthroplasty. Although the metal-on-metal (MoM) interface has gradually faded out of our vision, its revision is a clinical difficulty. Adverse reactions to metal debris (ARMD) is the most common indication for MoM hip arthroplasty revision, and the clinical results of hip arthroplasty due to ARMD are not satisfactory. At present, the indications and suggestions for revision of ARMD are not uniform. In this article, the clinical diagnosis, indications of revision, risk factors of prognosis, intraoperative suggestions and reasons for revision of ARMD were summarized. This article briefly introduces the diagnosis and treatment strategies and precautions of hip arthroplasty due to ARMD, in order to provide reference for such patients in clinical practice.

Arthroplasty, Replacement, Hip/adverse effects , Hip Prosthesis/adverse effects , Humans , Metal-on-Metal Joint Prostheses/adverse effects , Prosthesis Design , Prosthesis Failure , Reoperation
Acta ortop. mex ; 34(1): 47-52, ene.-feb. 2020. graf
Article in English | LILACS | ID: biblio-1345085


Abstract: Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there's also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.

Resumen: Introducción: La luxación anterior es una complicación poco frecuente de la artroplastia total de cadera (ATC). Sólo existen tres casos en la literatura. Ninguno de ellos informa del desmontaje de los componentes de la prótesis. Presentamos el caso una mujer obesa que sufrió una luxación irreducible de una artroplastia total de cadera (THA), la cual estaba infectada, debido a la aducción no controlada durante una cirugía de desbridamiento temprano. Después de los intentos fallidos de reducción cerrada, se presentó una fractura periprotésica clasificada como Vancouver B2 y el desmontaje de los componentes protésicos. Ameritó cirugía de revisión en dos etapas, lo cual se realizó para resolver la infección y restaurar la funcionalidad de la cadera. En la luxación obturatriz, la cabeza femoral puede quedar atrapada en el agujero obturador y, como consecuencia, favorecer la disociación de los componentes protésicos al intentar la reducción, asimismo puede favorecer un brazo de palanca que produzca una fractura periprotésica. La obesidad puede ser un factor determinante para la producción de esta rara complicación. Por todo lo anterior, se recomienda considerar de entrada la reducción abierta. La luxación obturatriz es una complicación rara en la artroplastia total de cadera; su tratamiento puede ser difícil y asociarse a fracturas. La relevancia de este caso es que permite mostrar algunas estrategias de manejo para prevenir complicaciones catastróficas.

Humans , Female , Obesity, Morbid/surgery , Obesity, Morbid/complications , Arthroplasty, Replacement, Hip/adverse effects , Periprosthetic Fractures/surgery , Periprosthetic Fractures/etiology , Femoral Fractures/surgery , Hip Dislocation/surgery , Hip Dislocation/etiology , Hip Prosthesis/adverse effects , Reoperation
An. bras. dermatol ; 94(3): 363-364, May-June 2019. graf
Article in English | LILACS | 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
Article in Spanish | LILACS, BINACIS | ID: biblio-1003008


Los recambios de cadera con cabezas metálicas grandes provocan una mayor tasa de complicaciones, principalmente asociadas al retiro del componente acetabular, como al par fricción utilizado. En casos determinados, pueden realizarse revisiones femorales aisladas, conservando la copa acetabular, disminuyendo la morbilidad quirúrgica. Presentamos un caso tratado exitosamente con una copa de doble movilidad, en un paciente con una prótesis de superficie con un seudotumor que generó dolor e inestabilidad. El conocimiento de esta técnica quirúrgica permite al cirujano de cadera resolver problemas complejos de forma sencilla y segura, con una baja tasa de complicaciones. Nivel de Evidencia: IV

Large head metal on metal hip arthroplasty revision has a significant complication rate, mainly related to the removal of the acetabular component, as well as to the friction pair used. In some cases, an isolated femoral revision can be made, sparing the acetabular cup and, thus, decreasing surgical morbidity. This paper discusses a case successfully treated with a dual mobility acetabular cup in a patient with a resurfacing hip replacement and a pseudotumor that caused pain and instability. Mastering this surgical approach allows hip surgeons to solve complex problems in a simple and safe manner, and with a low complication rate. Level of Evidence: IV

Aged , Reoperation , Hip Joint/surgery , Hip Prosthesis/adverse effects , Prosthesis Design
Article in English | WPRIM | ID: wpr-119057


BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

Adolescent , Adult , Arthroplasty, Replacement, Hip , Biocompatible Materials , Female , Hip Joint/diagnostic imaging , Hip Prosthesis/adverse effects , Humans , Joint Diseases/diagnostic imaging , Male , Metals/adverse effects , Metals, Heavy/poisoning , Middle Aged , Osteolysis/etiology , Poisoning/etiology , Polyethylene/adverse effects , Prosthesis Design , Prosthesis Failure/etiology , Reoperation , Young Adult
Rev. chil. infectol ; 31(4): 473-476, ago. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-724818


Infection is the most serious complication of arthroplasty. It's a rare event usually caused by Staphylococcus spp. Prosthetic tuberculosis is rarely reported. We report the case of a 41 year-old patient who underwent a hip replacement for osteoarthritis and after multiple procedures an infection caused by Mycobacterium tuberculosis was documented. We review the literature of previously reported cases.

La infección es la complicación más seria de una artroplastia. Es un evento poco frecuente, usualmente causado por especies de Staphylococcus. La tuberculosis protésica es una entidad poco habitual. Comunicamos el caso de una paciente de 41 años sometida a un reemplazo de cadera por una artrosis y después de múltiples procedimientos se documentó una infección por Mycobacterium tuberculosis. Realizamos una revisión de la literatura de los casos previamente reportados.

Adult , Female , Humans , Hip Prosthesis/adverse effects , Prosthesis-Related Infections/diagnosis , Tuberculosis, Osteoarticular/diagnosis , Mycobacterium tuberculosis/isolation & purification , Prosthesis-Related Infections/microbiology
Rev. bras. reumatol ; 51(6): 609-615, dez. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-624862


INTRODUÇÃO: A artrite reumatoide (AR) é uma das principais indicações de artroplastia total do quadril (ATQ) ou joelho (ATJ). Estudos internacionais indicam a AR como fator de risco para infecções de prótese. OBJETIVOS: Comparação entre pacientes com AR e osteoartrite (OA) de outras etiologias em relação à incidência de infecções de prótese, infecções incisionais e outras infecções sistêmicas pós-operatórias em ATQ e ATJ. MÉTODOS: Coorte retrospectiva, comparativa, de pacientes acompanhados após a realização de ATQ ou ATJ no Hospital SARAH-Brasília, no período entre 1996 e 2007. RESULTADOS: Setenta e cinco artroplastias em pacientes com AR foram identificadas, das quais 28 ATJ e 47 ATQ. Como controles, foram selecionadas 131 cirurgias em pacientes com OA, das quais 56 ATJ e 75 ATQ, de maneira aleatória e estratificada pela cirurgia e pelo gênero. Não houve diferenças significativas entre os grupos de AR e OA no que diz respeito às taxas de infecções de prótese (respectivamente, ATJ 7,1% vs. 0% e ATQ 2,1% vs. 0%, ambos com P > 0,1), infecção incisional (ATJ 14,3 vs. 3,3% e ATQ 4,3 vs. 1,3%, ambos com P > 0,1) e infecção sistêmica (ATJ 7,1 vs. 3,6%, P = 0,92 e ATQ 4,3 vs. 10,7%, P > 0,1). Após regressão logística múltipla, não houve alteração dos resultados. CONCLUSÕES: A presença de AR não foi identificada como fator de risco para infecções perioperatórias em ATQ e ATJ em casuística do Hospital SARAH-Brasília, em comparação com o grupo de pacientes com OA primária ou secundária a doenças não inflamatórias. A baixa incidência de infecções em ambos os grupos pode explicar os nossos achados.

INTRODUCTION: Rheumatoid arthritis (RA) is one of the major indications of total hip (THA) or knee (TKA) arthroplasty. International studies have suggested that RA is a risk factor for prosthesis infections. OBJECTIVES: To compare patients with RA and patients with osteoarthritis (OA) of other etiologies with regard to the incidence of prosthesis, incisional, and other systemic postoperative infections in THA and TKA. METHODS: Retrospective, comparative cohort of patients followed up after undergoing THA or TKA at the Hospital SARAH-Brasília, from 1996 to 2007. RESULTS: Seventy-five arthroplasties (28 TKA and 47 THA) were identified in RA patients. As controls, 131 surgeries (56 TKA and 75 THA) in OA patients were randomly selected and stratified by surgery and gender. No significant difference was observed between the RA and OA groups regarding the rates of prosthesis infections (TKA 7.1% vs. 0% and THA 2.1% vs. 0%, respectively, both with P > 0.1), incisional infections (TKA 14.3% vs. 3.3% and THA 4.3 vs. 1.3%, respectively, both with P > 0.1), and systemic infections (TKA 7.1% vs. 3.6%, P = 0.92 and THA 4.3% vs. 10.7%, P > 0.1, respectively). After multiple logistic regression, the results did not change. CONCLUSIONS: RA was not identified as a risk factor for perioperative infections in THA and TKA in this case series of the Hospital SARAH-Brasília, as compared with the group of patients with primary OA or OA secondary to non-inflammatory diseases. The low incidence of infections in both groups may explain our findings.

Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/surgery , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Hip Prosthesis/adverse effects , Infections/epidemiology , Knee Prosthesis/adverse effects , Osteoarthritis, Hip/surgery , Osteoarthritis, Knee/surgery , Prosthesis-Related Infections/epidemiology , Surgical Wound Infection/epidemiology , Incidence , Infections/etiology , Retrospective Studies
Rev. cuba. ortop. traumatol ; 25(1): 90-98, ene.-jun. 2011.
Article in Spanish | LILACS | ID: lil-615652


INTRODUCCION: El desgaste del polietileno ha sido un problema desde la introducción de la artroplastia total de baja fricción y continua siéndolo en la actualidad en lo que influyen múltiples condiciones. OBJETIVO: Describir las consideraciones técnicas necesarias en la artroplastia total de cadera en aras de garantizar la mayor durabilidad de sus componentes. MÉTODOS: Se realiza una revisión de la literatura publicada al respecto tomándose en cuenta las variables que afectan el desgaste del polietileno así como las maniobras técnicas que pueden ser realizadas por el cirujano en aras de optimizar la durabilidad de los componentes protésicos. RESULTADOS: La inclinación de la cúpula mayor de 45º está directamente relacionada con el desgaste del polietileno. La restauración del centro de rotación de la cadera con el centro de rotación de la cúpula ha sido un importante objetivo en la técnica de cementación del acetábulo debido a reportes de su relación con el desgaste. La cobertura por el hueso es importante para evitar el pinzamiento del cuello de metal contra el polietileno o el anillo de metal de la cúpula. CONCLUSIÓN: El cirujano puede cambiar el centro de rotación del acetábulo para obtener una óptima inclinación y cobertura de forma segura sin que implique un incremento de la incidencia del efecto adverso de desgaste

INTRODUCTION: The polyethylene wear has been a problem from the introduction of low fraction total arthroplasty until nowadays where influencing many conditions. OBJECTIVE: To describe the technical conditions needed in the total hip arthroplasty to guarantee a greater durability of its components. METHODS: Literature published on this subject is reviewed taking into account the variables affecting the polyethylene wear as well as the possible technical manoeuvres carried out by surgeon to optimize the durability of prosthetic components. RESULTS: The 45º slope of major cupula is directly related to polyethylene wear. Restoration of the hip rotation center with the cupula rotation center has been a significant objective in acetabulum cementation due to reports of its relation to wear. The bone coverage is important to avoid the metal neck clamping against the polyethylene or the metal ring of cupula. CONCLUSION: The surgeon may to change the acetabulum rotation center to achieve an optimal and safe slope and coverage without an increase of incidence of wear adverse effect

Humans , Male , Female , Arthroplasty, Replacement, Hip/methods , Prosthesis Design/methods , Polyethylenes/therapeutic use , Hip Prosthesis/adverse effects , Prosthesis Fitting/methods , Hip
Yonsei Medical Journal ; : 100-103, 2010.
Article in English | WPRIM | ID: wpr-71794


PURPOSE: This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. MATERIALS AND METHODS: The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10-15 years). RESULTS: The average Harris hip score at the time of final follow-up was 87.3 (range 77-94) points. Forty two hips (93.3%) showed excellent and good clinical results. Osteolysis occurred around the stem in 20 hips (44.4%) and around the cup in 26 hips (57.8%). Stress-mediated femoral resorption was observed in 33 hips (73.3%) at 10 years. There was no incidence of resorption progressing after 5 years postoperatively. There was no stem loosening. Five hips were revised for osteolysis, cup loosening and polyethylene wear. CONCLUSION: The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption.

Adult , Arthroplasty, Replacement, Hip/adverse effects , Female , Hip Prosthesis/adverse effects , Humans , Male , Osteolysis/etiology , Retrospective Studies , Treatment Outcome
Rev. chil. ortop. traumatol ; 50(4): 201-205, 2009. ilus, tab
Article in Spanish | LILACS | ID: lil-574203


Objectives: Determine periprosthetic fracture risk factors in our population, during Total Hip Arthroplasty. Material and Methods: A case-control study, comparing 52 cases of periprosthetic fracture against 100 control cases. Statistic analysis was made using Stata 11. Results: Comparing both groups, we observed a significative difference on age (p = 0.032), female gender (p = 0.05, OR 2.05), preoperative diagnosis of hip dysplasia (p = 0.043, OR 2.44), previous surgery (p = 0.005, OR 2.75), non cemented prosthesis (p = 0.001, OR 3.98), indicating that these are risk factors for periprosthetic fracture. A Poisson regression was made to evaluate surgeon experience influence on periprosthetic fractures. There was an inverse relationship between surgeon experience and fracture incidence (p < 0.01 ).We made a step-wise process to eliminate confusing factors; persisting risk factors are dysplasia, previous surgery and low surgeon experience which increase four times intraoperative risk of periprosthetic fracture. Conclusion: In our study, low surgeon experience, previous hip surgery and preoperative diagnosis of dysplasia increase four times periprosthetic fracture risk during a hip arthroplasty.

Objetivos: Determinar los factores de riesgo de presentar una fractura periprotésica durante una artroplastía total de cadera. Materiales y Métodos: Estudio del tipo caso y control. Se compararon 52 casos de pacientes con fracturas periprotésicas con 100 pacientes de grupo control. Se realizó un análisis estadístico mediante el programa Stata 11. Resultados: Al comparar ambos grupos, se observó que existían diferencias estadísticamente significativas (DES) en la edad (p = 0,032), el género femenino (p = 0,05, Odds ratio de 2,05), el diagnóstico preoperatorio de displasia de cadera (p = 0,043, Odds Ratio de 2,44), el antecedente de una cirugía anterior (p = 0,005, Odds Ratio de 2,75), el no cementar (p = 0,001, Odds ratio de 3,98), observándose que todas estas variables constituyen factores de riesgo para la aparición de fracturas periprotésicas. Al analizar la relación entre las tasas de fracturas con la experiencia del cirujano mediante una regresión de Poisson, se observó que existía una relación inversa entre la experiencia del cirujano y la incidencia de fracturas (p <0,01). Al introducir en un proceso step-wise las variables significativas para eliminar los factores confundentes asociados, se observa que los factores de riesgo que subsisten son la displasia, la cirugía previa y la menor experiencia del cirujano, las cuales aumentan el riesgo de presentar una fractura periprotésica intraoperatoria en 4 veces. Conclusión: En nuestra población de pacientes, la menor experiencia del cirujano, el antecedente de cirugía de cadera y el diagnóstico preoperatorio de displasia de cadera aumentan más de 4 veces el riesgo de presentar una fractura periprotésica durante un procedimiento de artroplastía de cadera.

Humans , Male , Female , Middle Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Hip Fractures/epidemiology , Case-Control Studies , Intraoperative Complications/epidemiology , Hip Fractures/classification , Hip Fractures/etiology , Hip Prosthesis/adverse effects , Risk Factors
Rev. Asoc. Argent. Ortop. Traumatol ; 72(2): 123-129, jun. 2007. ilus
Article in Spanish | LILACS | ID: lil-465423


Introduccion: La incidencia de las fracturas periprotesicas ha aumentado en las ultimas décadas y su resolucion representa un difícil desafío aun para los ortopedistas mas avezados. La clasificacion de Vancouver ha contribuido en gran medida a su mejor caracterizacion y orientacion terapeutica. El objetivo de este trabajo es efectuar una revisión de los ultimos avances en el tema y presentar nuestra experiencia en el tratamiento de esas fracturas. Materiales y metodos: Se describen las caracteristicas de una muestra de 46 pacientes con fracturas periprotesicas femorales asistidos en dos instituciones, desde marzo de 1995 hasta diciembre de 2005, tipificados según la clasificacion de Vancouver. Resultados: La edad promedio fue de 74,5 años, con un rango de 23 a 87 años y predominio femenino (71,73 por ciento). Cinco casos correspondieron al tipo A de la clasificacion, 32 casos al tipo B y 9 al tipo C. Se realizo tratamiento quirúrgico en 44 pacientes. El tiempo promedio de internacion fue de 12 días, con un rango de 9 a 34. El tiempo promedio de consolidacion en las fracturas de tipos B y C fue de 4 meses (rango, 3 a 6 meses). Seis pacientes sufrieron complicaciones. La resolucion fue evaluada como excelente en 10 casos (22,72 por ciento), buena en 28 casos (63,63 por ciento) y mala en 6 casos (13,65 por ciento). Conclusiones: Una exhaustiva evaluacion individual basada en la clasificacion de Vancouver, la edad y los requerimientos funcionales del paciente constituyen los parametros mas importantes para el exito terapeutico

Adult , Middle Aged , Aged, 80 and over , Fracture Fixation, Internal/methods , Femoral Fractures/surgery , Prosthesis Failure , Hip Prosthesis/adverse effects , Femoral Fractures/classification , Postoperative Complications , Reoperation , Treatment Outcome
Rev. Asoc. Argent. Ortop. Traumatol ; 70(4): 333-338, dic. 2005. ilus, tab
Article in Spanish | LILACS | ID: lil-442950


Introducción: Las fracturas de fémur asociadas con la prótesis total de cadera son un hecho infrecuente. La incidencia de estas fracturas informada en la literatura varía desde el 0,1 por ciento en la cirugía primaria al 4,2 por ciento en la cirugía de revisión. El tratamiento sin embargo es difícil y viene condicionado por diferentes factores: son pacientes de edad avanzada y con mala calidad del hueso. Materiales y métodos: Presentamos 59 pacientes operados en nuestro hospital por presentar una fractura periprotésica de fémur. La media de seguimiento fue de 7,3 años. Estos pacientes presentaban una fractura tipo A de la clasificación de Vancouver en 20 casos, tipo B en 24 casos y tipo C en 15 casos. Las fracturas fueron tratadas con recambio protésico en 24 casos, 33 casos con fijación interna, un caso con artroplastia resección de Girdlestone y un caso conservadoramente. En 21 casos se utilizaron injertos corticoesponjosos. Resultados: Al final del tratamiento hubo 7 complicaciones: 3 casos de seudoartrosis, 2 casos de infección y 2 casos de refractura. Al final del seguimiento 35 pacientes tenían un excelente o buen resultado, 17 un resultado regular y 12 un mal resultado (baremo de Merle D'Aubigne). El resultado fue mejor en los casos tratados con recambio protésico que en los tratados con fijación interna. Conclusiones: Se consiguió un buen resultado en los casos tratados con recambio protésico y un mal resultado en los tratados con osteosíntesis de la fractura. La clasificación de Vancouver es la mejor para escoger el tratamiento más adecuado.

Middle Aged , Femur , Hip Fractures , Hip Prosthesis/adverse effects , Fractures, Bone/classification , Postoperative Complications , Reoperation
Saudi Medical Journal. 2005; 26 (3): 429-33
in English | IMEMR | ID: emr-74852


Evaluate the cellular mechanisms responsible for the aseptic loosening of total hip replacements. Twenty periprosthetic membranes were collected during revision procedures at the Department of Orthopedics, Hacettepe University, Ankara, Turkey, during 1998 to 1999. Arthroplasties with polyethylene components and without polyethylene components were examined under light microscopy and immunohistochemically using the indirect immunoperoxidase technique into 2 different groups. Immunohistochemical analysis with monoclonal antibodies reactive to certain cell surface antigens [CD45, CD44, CD98, CD31, CD26, CD71] revealed different morphological characteristics regarding the adjacent fibrosis, leukocyte activation, and immunologic response. These findings suggested the role of different cellular mechanisms in each group

Humans , Hip Joint/diagnostic imaging , Hip Prosthesis/adverse effects , Prosthesis Failure , Prosthesis-Related Infections , Osteolysis , Cementation , Membranes/pathology , Immunohistochemistry , Bone Cements
Rev. mex. ortop. traumatol ; 15(5): 216-218, sept.-oct. 2001. ilus
Article in Spanish | LILACS | ID: lil-312252


Objetivo. Enfatizar la importancia de la correcta colocación del vástago femoral, debiendo evitar la fractura diafisiaria y la falsa vía femoral, que ocurre del 0 al 4.45 por ciento en diversas series. Material y métodos. Se presentan dos casos en quienes el vástago femoral perforó la cortical posterior en uno y la medial en otro, pudiendo en ambos casos los pacientes caminar. Resultados. Cuando se toma una sola radiografía, la imagen del vástago puede coincidir con la del fémur, dando una falsa apreciación de buena colocación, que a pesar de ser incorrecta, una vez estable, puede ser utilizado eventualmente mediante alguna actitud de compensación de la cadera, según la orientación de la prótesis. Conclusión. Debe aplicarse correctamente tanto la técnica quirúrgica como la radiológica transoperatoria, como siempre se ha establecido con un mínimo de dos proyecciones radiológicas que permitan identificar el error oportunamente. De otra manera podrá estar indicada la cirugía de revisión.

Humans , Female , Middle Aged , Arthroplasty, Replacement, Hip , Friction , Hip Prosthesis/adverse effects , Hip Prosthesis , Hip Fractures , Recovery of Function/physiology
Rev. mex. ortop. traumatol ; 15(5): 175-179, sept.-oct. 2001. ilus, tab
Article in Spanish | LILACS | ID: lil-312243


Objetivo. Evaluar la aparición de protrusión acetabular en pacientes con prótesis de Lazcano para la cadera después de dos a ocho años de colocada. Material y métodos. Se trata de una prótesis parcial monopolar cementada para la cadera, en cromo-cobalto, que fue diseñada con el vástago femoral similar al de Charnley y con collar de apoyo medial y ribete tipo cobra en el cuello. La cabeza de la prótesis tiene como particularidad que esta orientada con valguización de 145 grados, en lugar de los 135 estándar, ello con la finalidad de evitar la protrusión. La cabeza por lo demás es similar a las de Moore y de Thompson. De 51 pacientes con 52 caderas operadas entre los meses de noviembre de 1991 y de 1997, murieron siete en los siguientes 24 meses a la cirugía, permaneciendo 45 caderas para este estudio, que fueron una basicervical, nueve Garden II, cinco Garden III y 30 Garden IV. La edad fue en promedio de 74 años y el seguimiento de cinco años y tres meses. Resultados. De las 45 caderas, 36 no tuvieron desgaste acetabular (80 por ciento), mientras que nueve tuvieron un desgaste de 2 a 5 mm. No se encontró ningún caso de protrusión acetabular. Conclusión. Los resultados actuales nos permiten considerar a esta prótesis como un recurso favorable para las fracturas subcapitales, puesto que la dirección en 145 grados de valgo incrementado de la cabeza, no condicionan su protrusión al interior de la pelvis.

Humans , Male , Female , Middle Aged , Friction , Prosthesis Failure , Hip Prosthesis/adverse effects , Prosthesis Design/trends , Hip Prosthesis
Article in English | IMSEAR | ID: sea-44076


Biomechanic properties, bending stiffness and torsional strength, were determined in three different fixation techniques including lateral plating, lateral plating with cerclage wires, and 90 degrees-90 degrees anterior and lateral plating employed in treatment of the femoral shaft fracture with the presence of a femoral prosthesis. Five pairs of human femora with a man made cemented periprosthetic Johansson et al fracture classification type II were used in the experiments. The study showed that 90 degrees-90 degrees anterior and lateral plating produced the best increment in both biomechanic properties. In clinical practice, most of the soft tissue around femoral bone had to be dissected to do this technique, which would affect bone healing. Further study regarding the other properties, benefits, and disadvantages of these three techniques should be conducted before selecting the best method for treatment of the patients.

Adult , Analysis of Variance , Biomechanical Phenomena , Bone Plates , Bone Screws , Cadaver , Equipment Failure Analysis/methods , Female , Femoral Fractures/physiopathology , Fracture Fixation, Internal/instrumentation , Hip Prosthesis/adverse effects , Humans , Male , Middle Aged , Probability , Prosthesis Failure , Range of Motion, Articular , Sensitivity and Specificity , Tensile Strength
Rev. méd. Minas Gerais ; 11(1): 29-33, jan.-mar. 2001.
Article in Portuguese | LILACS | ID: lil-585833


Trata-se da revisão bibliográfica sobre as infecções decorrentes de cirurgias de implantação de prótese articular do quadril. São estudados seus aspectos epidemiológicos, diagnóstico, tratamento, prevenção e intervenções de enfermagem, objetivando a minimização do risco de infecção.

A review covering aspects to infections due to the surgical insertion of joint hip prosthetic devices is presented. The epidemiology of hospital infection, diagnosis, treatment, prevention and nursing, interventions to minimize infection risks are considered.

Humans , Postoperative Complications/prevention & control , Orthopedic Nursing , Hip Prosthesis/adverse effects , Postoperative Complications/nursing