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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367138

ABSTRACT

Introducción: En pacientes con fracturas de fémur distal con alto grado de conminución metafisaria (AO 33 C2, C3) y fracturas periprotésicas (Vancouver tipo C), el uso de doble osteosíntesis brinda mayor estabilidad a la fractura. Las placas helicoidales se emplean cada vez más con el objetivo de evitar dañar elementos nobles relacionados con el abordaje. Materiales y métodos: Entre 2017 y 2021, seis pacientes fueron tratados mediante osteosíntesis con doble placa (por vía lateral y helicoidal por vía medial). La serie se compone de cuatro mujeres y dos hombres. El 66% (4 pacientes) tenía fracturas de fémur distal, y el resto (33%), fracturas periprotésicas tipo Vancouver C. Resultados: Se observó la consolidación radiográfica en todos los pacientes, a los 6 meses de la cirugía, con retorno normal a la actividad previa. Ninguno sufrió una lesión vasculonerviosa asociada. Conclusiones: La placa helicoidal es una gran opción para las fracturas de fémur distal con conminución y las fracturas femorales periprotésicas tipo Vancouver C. Esto demuestra que, aplicando los principios básicos de osteosíntesis, con una técnica sencilla, se pueden suplir materiales más sofisticados, y obtener resultados radiográficos similares. Nivel de Evidencia: IV


Introduction: The use of double osteosynthesis for the treatment of fractures of the distal femur with metaphyseal comminution (AO 33C2, C3) and periprosthetic fractures (Vancouver C) provides greater stability. The use of helical plates has increased in or-der to avoid vascular damage related to the approach. Materials and methods: Between 2017 and 2021, six patients were treated by double plate osteosynthesis (helical plate by medial approach). The series consisted of four females and two males, 66% (4 patients) had distal femoral fractures, and the rest (33%, 2 patients) were diagnosed with Vancouver C periprosthetic fractures. Results: In all cases, radiographic consolidation was observed 6 months after surgery, with a normal return to activities of daily living. None of them presented an associated neurovascular injury. Conclusion: The helical plate is a great option in distal femur fractures and Vancouver C periprosthetic femoral fractures. By applying the basic principles of osteosynthesis, sophisticated ma-terials can be supplied, obtaining good clinical, functional, and radiographic outcomes. Level of Evidence: IV


Subject(s)
Bone Plates , Periprosthetic Fractures , Femoral Fractures/surgery , Fracture Fixation, Internal , Knee Injuries
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353984

ABSTRACT

Objetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas. Materiales y métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral. Resultados: Se realizó una cirugía de revisión en dos etapas en cuatro pacientes. Se registraron cinco fallas asépticas del implante y dos luxaciones en toda la serie. El análisis de regresión lineal multivariable mostró una asociación significativa entre el grado del defecto óseo femoral Endo-Klinik y la tasa de complicaciones (p = 0,04). Conclusión: La reconstrucción femoral con la técnica de injerto óseo impactado para tratar fracturas periprotésicas Vancouver B3 provocó una alta tasa de complicaciones. Nivel de Evidencia: IV


Aims: Because the gold standard for the treatment of Vancouver type B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate of the impaction bone grafting (IBG) technique with a cemented stem for the treatment of this fractures. Materials and methods: We retrospectively studied 33 B3 PFFs treated with the IBG technique oper-ated between 2000 and 2016, analyzing the complication rate. The median follow-up was 75 months (interquartile range [IQR], 36-111). The median age was 78 years (IQR, 74-83). The median grade of EndoKlinik femoral bone defect was 3 (IQR, 3-3). Weperformed a multiple regression analysis to determine risk factors for complications, including the following variables: number ofprevious surgeries, femoral head diameter, and femoral bone defect. Results: As for infection outcomes, 2-stage revision surgerywas performed in 4 patients. We registered 5 implant failures and 2 dislocations in the whole series. Multiple regression analysisshowed a significant association between the grade of EndoKlinik femoral bone defect and complication rate (P=0.04). Conclu-sion: Femoral reconstruction with the IBG technique evidenced a high complication rate for the treatment of B3 PFF. Level of Evidence: IV


Subject(s)
Postoperative Complications , Reoperation , Bone Transplantation , Treatment Outcome , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Hip Fractures/surgery
3.
Article in Chinese | WPRIM | ID: wpr-879425

ABSTRACT

OBJECTIVE@#To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA).@*METHODS@#From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation.@*RESULTS@#All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant (@*CONCLUSION@#The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.


Subject(s)
Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Female , Femoral Fractures/surgery , Fracture Fixation, Internal , Hip Prosthesis , Humans , Male , Middle Aged , Periprosthetic Fractures/surgery , Reoperation , Retrospective Studies , Treatment Outcome
4.
Acta ortop. mex ; 34(1): 47-52, ene.-feb. 2020. graf
Article in English | LILACS | ID: biblio-1345085

ABSTRACT

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.


Subject(s)
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
5.
Article in Korean | WPRIM | ID: wpr-811280

ABSTRACT

Although the incidence of postoperative periprosthetic femoral fractures after hip arthroplasty is expected to increase, these complex fractures are still challenging complications. To obtain optimal results for these fractures, thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are mandatory. The Vancouver classification system is a simple, effective, and reproducible method for planning proper treatments of these injuries. The fractures associated with a stable femoral stem can be effectively treated with osteosynthesis, though periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. We describe here the principles of proper treatment for the patients with periprosthetic femoral fractures as well as how to avoid complications.


Subject(s)
Arthroplasty , Classification , Femoral Fractures , Femur , Hip , Humans , Incidence , Methods , Periprosthetic Fractures
6.
Article in Korean | WPRIM | ID: wpr-811279

ABSTRACT

Recently, as the elderly population increases, the incidence of total knee arthroplasty has increased, with a concomitant increase in the frequency of periprosthetic fractures. To determine the treatment plan for fractures, the treatment method should be determined by the patient's age, osteoporosis, fixation status of the implant, and type of fracture. In recent years, operative treatment with reduction and stable fixation, rather than non-operative treatment, was used to promote early joint movement and gait. On the other hand, it is necessary to select an appropriate operative method to reduce complications of surgery, such as nonunion and infection, and expect a good prognosis. In this review, periprosthetic fractures were divided into femur, tibia, and patella fractures, and their causes, risk factors, classification, and treatment are discussed.


Subject(s)
Aged , Arthroplasty , Arthroplasty, Replacement, Knee , Classification , Femur , Gait , Hand , Humans , Incidence , Joints , Knee , Methods , Osteoporosis , Patella , Periprosthetic Fractures , Prognosis , Risk Factors , Tibia
7.
Article in Chinese | WPRIM | ID: wpr-828289

ABSTRACT

OBJECTIVE@#To evaluate the clinical effect of bridge combined internal fixation system in the treatment of periprosthesis fracture of femur after hip replacement.@*METHODS@#From October 2016 to June 2018, 5 patients of periprosthesis fractures of femur classified type B1 and type C in Vancouver were treated by open reduction and bridging combined with internal fixation, including 2 males and 3 females, with ages of 68, 70, 74, 75, 79 years;type B1 fractures in 4 and type C fractures in 1. Causes of injury:1 case of traffic injury, 4 cases of fall. After the operation, the patients were followed up for complications and fracture healing time by clinical and imaging examination, and Parker activity score was performed.@*RESULTS@#The wounds of 5 patients healed without infection. One case of DVT was confirmed by venography. Five patients were followed up, and the durations were 2, 8, 9, 10, 15 months. One patient died of myocardial infarction 2 months after operation. The average healing time was 12.5 weeks. No loss of reduction or failure of internal fixation was found. Two patients could walk without protection and 1 patient needed to rely on single crutch. One case of periprosthetic fracture had to walk with a single crutch before operation and move indoors with two crutches after operation. The average Parker activity score was 51.8% before operation.@*CONCLUSION@#The bridge combined internal fixation system can be used to fix the fracture after hip replacement with stable femoral prosthesis.


Subject(s)
Aged , Arthroplasty, Replacement, Hip , Bone Plates , Female , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Fracture Healing , Humans , Male , Periprosthetic Fractures , General Surgery , Radiography , Reoperation , Retrospective Studies , Treatment Outcome
8.
Article in Korean | WPRIM | ID: wpr-766421

ABSTRACT

PURPOSE: Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion. MATERIALS AND METHODS: This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion. RESULTS: The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045). CONCLUSION: The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.


Subject(s)
Aged , Bone Diseases , Femoral Fractures , Femur , Follow-Up Studies , Humans , Logistic Models , Medical Records , Miners , Mortality , Periprosthetic Fractures , Prognosis , Prospective Studies , Retrospective Studies , Risk Factors
9.
Article in Korean | WPRIM | ID: wpr-766409

ABSTRACT

Periprosthetic acetabular fracture (PAF) is an uncommon complication following hip arthroplasty. However, as the number of people needing hip prostheses continues to rise, the absolute number of PAF is expected to increase as well. These fractures may occur either intraoperatively or postoperatively. Postoperative fractures can be caused by traumatic events or by pathologic conditions related to periacetabular osteolysis. The management of PAF usually depends on the degree of displacement and the stability of the acetabular component. While most of non-displaced fractures can be managed nonoperatively by protected weight bearing, displaced fractures with unstable implants require surgical intervention, which is often technically challenging. This review summarized the latest findings on the epidemiology, the diagnosis, the classification, and the treatment of PAF.


Subject(s)
Acetabulum , Arthroplasty , Classification , Diagnosis , Epidemiology , Hip Prosthesis , Hip , Osteolysis , Periprosthetic Fractures , Weight-Bearing
10.
Hip & Pelvis ; : 206-215, 2019.
Article in English | WPRIM | ID: wpr-763983

ABSTRACT

PURPOSE: Short-term outcomes following cemented and cementless hemiarthroplasties (HAs) are reported to be comparable, however, long-term outcomes of cementless HA—especially among Asian patients—is limited. We aimed to assess long-term outcomes in elderly East-Asian patients with intracapsular proximal femoral fractures treated with cementless HA. MATERIALS AND METHODS: We enrolled 135 patients treated with cementless HA who met our inclusion criteria. We documented bone/implant-related complications (e.g., incidences of revision hip surgery, femoral stem subsidence, dislocation, intraoperative and postoperative periprosthetic fractures, contralateral hip fractures). We included those patients who are still alive 10 years after the index surgery in the final functional analysis of the existence of pain, ambulatory status, and residential status. RESULTS: The mean age at injury was 78.3 years (range: 60–85 years). At the 10-year follow-up, 26 of the original patients (19.3%) had survived. During follow-up, revision hip surgery was conducted in two patients (1.5%). We recorded the incidence of intraoperative fractures, postoperative periprosthetic fractures, and contralateral fractures in two (1.5%), eight (5.9%), and six patients (4.4%), respectively. Among the 10-year survivors, six patients (23.1% of the survivors) complained of groin pain, but generally reported the pain to be tolerable. CONCLUSION: Among elderly East-Asian patients, the incidence of revision surgery after cementless HA may be lower than that in their European counterparts, whereas the incidence of periprosthetic fractures can still be considerably higher. For patients undergoing cementless HA, prevention of such secondary fractures is of critical importance.


Subject(s)
Aged , Asians , Joint Dislocations , Femoral Fractures , Femoral Neck Fractures , Follow-Up Studies , Groin , Hemiarthroplasty , Hip , Hip Fractures , Humans , Incidence , Osteoporosis , Periprosthetic Fractures , Survivors
11.
Hip & Pelvis ; : 166-173, 2019.
Article in English | WPRIM | ID: wpr-763972

ABSTRACT

PURPOSE: To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct. MATERIALS AND METHODS: A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed. RESULTS: At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II. CONCLUSION: The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.


Subject(s)
Allografts , Arthroplasty, Replacement, Hip , Bone Density , Femoral Fractures , Follow-Up Studies , Hip , Humans , Osteoporosis , Periprosthetic Fractures , Retrospective Studies
12.
Article in Chinese | WPRIM | ID: wpr-773878

ABSTRACT

OBJECTIVE@#To explore risk factors of the periprosthetic fracture after hip arthroplasty.@*METHODS@#Potential studies were searched in databases including Pubmed, Embase, Cochrane Library, CNKI as well as Wanfang Database up to November 2018 and references in related literatures. The methodological quality of literature was estimated by Newcastle-Ottawa Scale. Raw data were merged and tested mainly by Revmain 5.3.@*RESULTS@#Seventeen studies in total were appropriate with 90 632 patients. The results revealed that it increased the risk of periprosthetic fracture after hip arthroplasty, including female (=1.62, 95%CI:1.44 to 1.82, =3.@*CONCLUSIONS@#Orthopedics doctors should constantly be cantious about the risk factors including female, revision and diagnosis of rheumatoid arthritis. They are supposed to prevent the periprosthetic fracture by gentle operation during hip arthroplasty and monitoring the functional exercise after operations when the above risk factors occur.


Subject(s)
Arthroplasty, Replacement, Hip , Female , Femoral Fractures , Humans , Periprosthetic Fractures , Reoperation , Risk Factors
13.
Article in Chinese | WPRIM | ID: wpr-773854

ABSTRACT

OBJECTIVE@#To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).@*METHODS@#From July 2010 to June 2017, 21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach. Fifteen patients in medial and lateral double approaches group, including 5 males and 10 females aged from 63 to 79 years old with an average of (67.2±5.9) years old; 11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification; 12 patients injured by falling down and 3 patients by traffic accident; treated with double plating. Six patients in medial parapatellar approach group, including 3 males and 3 females, aged from 61 to 74 years old with an average of (64.6±6.0) years old; 3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification; 5 patients injured by falling down and 1 patient by traffic accident; treated with double plating. Operative time, blood loss, postoperative drainage, fracture healing time were compared between two groups; HSS score and radiology at 3 and 12 months were compared between two groups.@*RESULTS@#All patients were followed up, and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of (14.2±2.6 ) months, while the follow-up time of single approach group ranged from 12 to 16 months with an average of (12.6±2.5) months, and there was no statistical difference between two groups. The operative time and postoperative drainage in bilateral approaches group were (107.2±10.4) min and (213.9±30.4) ml, while in sigle approach group was (95.4±12.8) min and (256.8±34.2) ml, and the differences were significant(0.05). HHS score at 3 and 12 months after operation in bilateral approach were 82.9±5.7 and 84.8±7.1, while in single approach group were 83.6±6.1 and 86.3±6.8; there was no statistical difference in HSS score between two groups(>0.05). According to HSS score at 12 months after operation, 2 cases got excellent results and 13 good in bilateral approaches group; 1 case got excellent result and 4 good and 1 moderate in single approach group; but there was no statistical difference between two groups (χ²=2.625, =0.105). There wase no significant differences in complications between bilateral approaches group(2 cases) and single approach group (1 case)(>0.05).@*CONCLUSIONS@#Double plating technique for communicated and obvious osteoporosis periprosthetic femoral fracture following TKA could obtain good function of knee joint. The medial parapatellar approach has shorter operative time, while the bilateral approaches had less drainage.


Subject(s)
Aged , Arthroplasty, Replacement, Knee , Female , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Humans , Male , Middle Aged , Periprosthetic Fractures , General Surgery , Treatment Outcome
14.
Article in Korean | WPRIM | ID: wpr-770052

ABSTRACT

The rapidly increasing rate of shoulder arthroplasty is certain to increase the number of revision arthroplasties because of parallel increases in complication numbers. It has been widely reported that the causes of revision shoulder arthroplasty include rotator cuff deficiency, instability, glenoid or humeral component loosening, implant failure, periprosthetic fracture, and infection. Revision arthroplasty can be technically challenging, and surgical options available for failed shoulder arthroplasty are limited, especially in patients with glenoid bone loss or an irreparable rotator cuff tear. Furthermore, the outcomes of revision arthroplasty are consistently inferior to those of primary arthroplasty. Accordingly, surgical decision making requires a good understanding of the etiology of failure. Here, we provide a review of indications of revision arthroplasty and of the surgical techniques used by failure etiology.


Subject(s)
Arthroplasty , Decision Making , Humans , Periprosthetic Fractures , Risk Factors , Rotator Cuff , Shoulder , Tears , Treatment Failure
15.
Article in Korean | WPRIM | ID: wpr-770032

ABSTRACT

PURPOSE: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. MATERIALS AND METHODS: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. RESULTS: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21–27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12–13). The average range of motion of the 10 CFTR cases was 67° (0°–100°). The mean extension lag of 10 cases was 48° (20°–80°). CONCLUSION: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.


Subject(s)
Arthrodesis , Cicatrix , Debridement , Diagnosis , Extremities , Femur , Follow-Up Studies , Humans , Joints , Knee Joint , Knee , Limb Salvage , Neoplasm Metastasis , Osteosarcoma , Periprosthetic Fractures , Prostheses and Implants , Prosthesis Implantation , Range of Motion, Articular , Recurrence , Retrospective Studies , Tibia
16.
Hip & Pelvis ; : 33-39, 2019.
Article in English | WPRIM | ID: wpr-740449

ABSTRACT

PURPOSE: The difficulty of femoral preparation with supine-position hip hemi-arthroplasty (HA) often leads to intra-operative fractures (IOFs). We aimed to clarify the incidence and types of IOFs in HA for hip fractures performed in the supine and lateral positions. MATERIALS AND METHODS: We retrospectively investigated cases of HA for acute femoral neck fractures from June 2013 to May 2018. We examined the incidence and types of IOFs according to different approaches. We defined supine-position in HA as the supine and hip-hyperextended (over-range) femoral preparation position, and lateral position as the lateral and hip-flexed femoral preparation position. We used a short tapered wedged stem. RESULTS: Supine-position HA was used in 46 patients (23.7%) and lateral-position HA in 148 patients (76.3%). IOFs in supine-position HA occurred in 8 patients (17.4%) and included five Vancouver AGT and three Vancouver B2 fractures. IOFs in lateral-position HA occurred in 3 patients (2.0%) and included one Vancouver AGT and two Vancouver B fractures. Supine-position HA was a risk factor for IOFs (adjusted odds ratio, 9.71; 95% confidence interval, 2.37–39.8; P < 0.01) CONCLUSION: Supine-position in HA is an IOF risk factor and significantly increases the incidence of great trochanter fractures of Vancouver type A.


Subject(s)
Arthroplasty, Replacement, Hip , Femoral Neck Fractures , Femur , Hemiarthroplasty , Hip Fractures , Hip , Humans , Incidence , Minimally Invasive Surgical Procedures , Odds Ratio , Periprosthetic Fractures , Retrospective Studies , Risk Factors
17.
Article in English | WPRIM | ID: wpr-763615

ABSTRACT

Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients. Total elbow prostheses have evolved over the years and now include the linked, unlinked, and convertible types. However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Here, we introduce each type of implant and evaluate clinical outcomes and complications by reviewing the previous literature.


Subject(s)
Aged , Arthritis , Arthritis, Rheumatoid , Arthroplasty , Elbow Prosthesis , Elbow , Humans , Osteoarthritis , Periprosthetic Fractures , Reoperation , Treatment Outcome
18.
Acta ortop. mex ; 32(1): 48-52, ene.-feb. 2018. graf
Article in Spanish | LILACS | ID: biblio-1019328

ABSTRACT

Resumen: Introducción: Las fracturas periprotésicas de cadera son aquéllas que ocurren a nivel femoral y acetabular. A estas fracturas se asocia una amplia variedad de problemas como la conminución, la pérdida ósea y con frecuencia el aflojamiento del vástago femoral. El tratamiento de estas fracturas ha estado históricamente asociado a altas tasas de fracasos del tratamiento, de complicaciones y de resultados insatisfactorios. Objetivo: Presentar el caso clínico-radiográfico del tratamiento de una fractura periprotésica con revisión femoral y reconstrucción metafisaria con lajas de cortical y cables de acero en un paciente multioperado. Material y métodos: Se presenta el caso de un paciente con luxación de prótesis total de cadera izquierda de revisión + fractura periprotésica Vancouver B3, a quien se le realiza revisión de componente femoral y reconstrucción metafisaria proximal de fémur con aloinjerto óseo en lajas y fijación con cables de acero. Resultados: El paciente cursa con adecuada evolución al año de postoperado, deambulando con apoyo de bastón, control radiográfico y adecuada congruencia de los componentes protésicos y datos de consolidación de la fractura. Discusión: En el tratamiento de las fracturas periprotésicas es posible recurrir a la reconstrucción mediante el uso de aloinjertos en laja de cortical, cerclados con cables de acero, con buenos resultados funcionales y radiológicos.


Abstract: Introduction: Periprosthetic hip fractures are those that occur at the femoral and acetabular level. These fractures are associated with a wide variety of problems such as comminution, loose of bone stock and loosening of the femoral stem. Treatment of these fractures has historically been associated with high rates of treatment failures, complications and unsatisfactory outcomes. Objective: To present the clinical-radiographic case of the treatment of a periprosthetic hip fracture, with a femoral revision and metaphyseal reconstruction with cortical strut allograft and cerclage cables, in a multioperated patient. Material and methods: We present the case of a patient with a dislocation of a revision total hip prosthesis with a periprosthetic fracture type B3 of the Vancouver classification, who underwent a revision of the femoral component and a proximal metaphyseal reconstruction of the femur with cortical strut allograft and cerclage cables. Results: The patient had an adequate evolution at the postoperative year, walking with a cane, radiographic control with adequate congruence of the prosthetic components and data of consolidation of the fracture. Discussion: In the treatment of periprosthetic fractures, reconstruction can be done with use of cortical strut allograft and cerclage cables, with good functional and radiological results.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Periprosthetic Fractures/surgery , Femoral Fractures/surgery , Hip Fractures/surgery , Hip Prosthesis , Reoperation , Treatment Outcome , Allografts
19.
Einstein (Säo Paulo) ; 16(1): eRC4037, 2018. graf
Article in English | LILACS | ID: biblio-891461

ABSTRACT

ABSTRACT Periprosthetic fractures is a severe complication after joint replacement. The rapidly increase of reverse shoulder arthroplasty surgeries, periprosthetic humeral fractures, which are described as rare, may increase in the near future. We report the case of displaced humeral fracture bellow the stem of reverse shoulder prosthesis. The patient was an 85-year-old woman who had a total shoulder replacement 6 years previously. The surgical solution consisted of plate osteossynthesis and cerclage. This report describes an unprecedented case in Brazilian literature; and gives an overview of the existing literature including this injury classification.


RESUMO As fraturas periprotéticas do ombro representam uma grave complicação após a substituição da articulação. Devido ao rápido aumento do número de cirurgias de artroplastia reversa no ombro, as fraturas periprótese do úmero, descritas como raras, podem aumentar no futuro próximo. Descrevemos um caso de fratura desviada do úmero abaixo do componente umeral de uma artroplastia reversa. A paciente era uma mulher de 85 anos de idade, que tinha uma artroplastia reversa do ombro há 6 anos. O tratamento cirúrgico consistiu em osteossíntese com placa, parafusos e cerclagem. Os objetivos do presente trabalho foram reportar um caso inédito na literatura brasileira, e revisar a literatura existente e as classificações da lesão.


Subject(s)
Humans , Female , Aged, 80 and over , Periprosthetic Fractures/surgery , Arthroplasty, Replacement, Shoulder , Humeral Fractures/surgery , Bone Plates , Treatment Outcome , Periprosthetic Fractures/diagnostic imaging , Humeral Fractures/diagnostic imaging
20.
Chinese Journal of Traumatology ; (6): 329-332, 2018.
Article in English | WPRIM | ID: wpr-771651

ABSTRACT

PURPOSE@#Periprosthetic fracture (PPF) is a serious complication that occurs in 0.3%-2.5% of all total knee arthroplasties used to treat end-stage arthritis. To our knowledge, there are no studies in the literature that evaluate the association between time to surgery after PPF and early postoperative infections or deep vein thrombosis (DVT). This study tests our hypothesis that delayed time to surgery increases rates of postoperative infection and DVT after PPF surgery.@*METHODS@#Our study cohort included patients undergoing PPF surgery in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2015). The patients were dichotomized based on time to surgery: group 1 with time ≤2 days and group 2 with time >2 days. A 2-by-2 contingency table and Fisher's exact test were used to evaluate the association between complications and time to surgery groups, and multivariate logistic regression was used to adjust for demographics and known risk factors.@*RESULTS@#A total of 263 patients (80% females) with a mean age of 73.9 ± 12.0 years were identified receiving PPF surgery, among which 216 patients were in group 1 and 47 patients in group 2. Complications in group 1 included 3 (1.4%) superficial infections (SI), 1 (0.5%) organ space infection (OSI), 1 (0.5%) wound dehiscence (WD), and 4 (1.9%) deep vein thrombosis (DVT); while complications in group 2 included 1 (2.1%) SI, 1 (2.1%) OSI, 1 (2.1%) DVT, and no WD. No significant difference was detected in postoperative complications between the two groups. However, patients in group 2 were more likely (p = 0.0013) to receive blood transfusions (57.5%) than those in group 1 (32.4%).@*CONCLUSION@#Our study indicates patients with delayed time to surgery have higher chance to receive blood transfusions, but no significant difference in postoperative complications (SI, OSI, WD, or DVT) between the two groups.


Subject(s)
Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee , Blood Transfusion , Cohort Studies , Female , Humans , Infections , Epidemiology , Logistic Models , Male , Middle Aged , Periprosthetic Fractures , General Surgery , Postoperative Complications , Epidemiology , Risk Factors , Surgical Wound Dehiscence , Epidemiology , Surgical Wound Infection , Epidemiology , Time Factors , Venous Thrombosis , Epidemiology
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