Analysis of Protrusio Acetabuli Using a CT-based Diagnostic Method in Korean Patients with Marfan Syndrome: Prevalence and Association with Other Manifestations

A new CT-based diagnostic method of protrusio acetabuli (PA) was introduced. However, prevalence of PA by this method and correlation between PA and other manifestations of Marfan syndrome (MFS) is unknown in Korean MFS patients. This study aimed to investigate the prevalence of PA diagnosed by a CT-based method in Korean patients with MFS, the association of PA with other manifestations of MFS, and the contribution of PA to MFS diagnosis. We retrospectively reviewed the records of 146 MFS patients with the presence of a causative FBN1 mutation and 146 age- and sex-matched controls from a single tertiary care center. All MFS patients underwent a complete assessment of criteria based on the revised Ghent nosology. PA was assessed quantitatively using a CT-based circle-wall distance (CWD) method. PA was diagnosed in 77.4% of patients in the MFS group and in 11.0% of the control group. CWD was significantly different between the two groups (1.50 mm vs. -0.64 mm, P<0.001). The presence of PA did not correlate with the presence of ectopia lentis, aortic root diameter, or history of aortic dissection. The presence of PA did not have a significant impact on the final diagnosis of MFS. Even though the presence of PA does not related to the cardinal clinical features of MFS or influence MFS diagnosis, its presence may be helpful for the suspicion of MFS when aortic dissection or aneurysm is found on CT angiography of the aorta because of the high frequency of PA in MFS patients.

Revisión de conceptos actuales: actualización en pinzamiento femoroacetabular / Current concepts: labral hip impingement

Durante el último siglo múltiples autores han sugerido que la etiología de la osteoartritis (OA) de la cadera se encuentra relacionada más con la morfología que con la carga que esta recibe. Recientemente fue propuesto el concepto de pinzamiento femoroacetabular (PFA) como una explicación del papel que juegan las distintas alteraciones morfológicas de la cadera en el desarrollo de OA en pacientes jóvenes sin displasia. Históricamente se han descrito múltiples patologías (enfermedad de Legg-Calvé-Perthes, fracturas del fémur proximal, deslizamiento epifisario de la cabeza femoral, displasia del desarrollo de la cadera, etc.) capaces de desencadenar el desarrollo de OA de la cadera, pero las mismas representan un porcentaje muy bajo y la mayoría de los pacientes que la desarrollan carecen de condiciones predisponentes. Sin embargo, la evidencia reciente muestra que en pacientes activos las alteraciones morfológicas sutiles que afectan al fémur proximal o el acetábulo son la causa más común de pinzamiento femoroacetabular.

The Correlations of the Radiological Parameters of Hip Dysplasia and Proximal Femoral Deformity in Clinically Normal Hips of a Korean Population

BACKGROUND: The aim of this study was to answer the following two questions: 1) Do the radiological parameters of dysplasia have significant correlations between themselves or with the parameters of the proximal femoral deformity and vice versa? 2) Do the physical parameters have a significant correlation with the radiological parameters of hip dysplasia and proximal femoral deformity? METHODS: Four hundred and twenty eight consecutive patients with no clinical evidence of hip osteoarthritis and who underwent pelvic radiography in the supine position for hip contusion or a routine health check were analyzed for the relationships between the center-edge (CE) angle, acetabular depth, acetabular angle, the head-neck ratio and the neck-shaft angle as well as the relationships of the above-mentioned variables with age, gender, body height and the body mass index. RESULTS: The CE angle, acetabular depth and acetabular angle showed a strong correlation with each other. The neck-shaft angle and the head-neck ratio showed no correlation with each other or with the CE angle, acetabular depth and acetabular angle. Age was positively associated with the CE angle, and inversely associated with the acetabular depth or acetabular angle. Male gender was significantly associated with the increased neck-shaft angle, and inversely associated with the head-neck ratio. CONCLUSIONS: The radiological parameters of hip dysplasia are all strongly, if not perfectly, inter-correlated. Age was associated with the radiological parameters of hip dysplasia whereas gender was associated with the radiological parameters of a proximal femoral deformity.

Osteoplastía femoroacetabular sin luxación coxofemoral en el síndrome de choque femoroacetabular: valoración de la calidad de vida / Femoroacetabular osteoplasty without coxofemoral dislocation in the femoroacetabular impingement syndrome: quality of life assessment

Introducción: El choque femoroacetabular es causa de lesiones del labrum y de coxartrosis en los pacientes jóvenes. Existe escasa evidencia sobre los resultados terapéuticos mediante la osteoplastia coxofemoral por vía anterior sin luxación. El objetivo de este trabajo fue analizar una serie de pacientes tratados con dicha técnica centrándose en los cambios en la calidad de vida. Materiales y métodos: En 22 pacientes con síndrome de tipo cam se realizaron 24 queilectomías y 9 plásticas labrales mediante exposición anterior “reducida”, capsulotomía anterior y osteoplastia insitu. Edad promedio: 44 años; seguimiento promedio: 24 meses. Se documentaron las complicaciones, la amplitud de movimiento y las imágenes radiológicas (Tõnnis). Se definieron los niveles de calidad de vida en pobre, aceptable, buena y muy buena, según el dolor, la escala WOMAC y la reinserción deportiva. Resultados: La amplitud de movimiento aumentó en todos los pacientes. Se comprobó progresión radiológica en 4 casos. Después de 18 meses, 14 permanecían asintomáticos, con calidad de vida muy buena y 3, con buena. Como única complicación se produjo paresia temporal del femorocutáneo en 3 pacientes. Conclusiones: El progreso de la cirugía reconstructiva supone la realización de procedimientos poco agresivos que disminuyan las complicaciones secundarias y permitan una pronta reinserción a las actividades diarias. Esta técnica permite acceder a los osteofitos cervicales y al labrum anterior, donde se localizan 70 por ciento de las lesiones.

Revision total hip replacement in severe acetabular bone deficiency

Acetabular bone deficiency is one of the main problems in hip revision. The aim of this study is to evaluate the results of revision hip replacement using stemmed acetabular component. Twenty one hips in 18 patients had revision total hip replacement using the stemmed acetabular reinforcement ring and impaction grafting technique for reconstruction of type III [combined segmental / cavitary] acetabular bone deficiency. A new method of measurements of migration was developed using a personal computer, scanner and a new software [Roman] developed in Robert Jones and Agnus Hunt Orthopaedic Institute, Oswestry, United Kingdom. The overall results revealed satisfactory results in 18 hips [90%] after a mean period of follow-up of 3.8 years. Failure was in 2 cases [10%] due to infection. The mean postoperative hip score improved from 50 points to 87.3 points. The mean vertical migration was 4.57 mm while the mean horizontal migration was 4.11 mm. 2 patients showed significant radiolucent lines and the cup was considered loose. 4 hips [19%] showed grade I heterotopic ossification [HO], one hip [5%] showed grade II HO. and one [5%] had grade III HO. 16 hips [76%] showed complete incorporation of the bone graft. Two hips [10%] had deep infection and considered clinical and radiological failure. Five hips had post operative dislocation and were managed conservatively without the need for any surgical intervention

Charnley Ogee-flanged cup in primary total hip arthroplasty for acetabular dysplasia

Ogee-flanged socket was introduced by Sir John Charnley for use in low-friction hip arthroplasty. The results of 18 primary total hip arthroplasties performed in 17 patients with moderate congenital acetabular dysplasia were reviewed. Charnley total hip prosthesis including a non-modular femoral stem and an ogee-flanged acetabular socket were used in all patients. The average duration of follow up after arthroplasty was 5.3 years [range 4-7 years]. All patients were evaluated using a modified Harris hip scoring system and a standardized anteroposterior pelvis radiograph for hips. Differences between the preoperative and postoperative [last evaluation] scores were assessed with the student's t-test and Chi-square test. The mean overall modified Harris hip score was improved from 48 points preoperatively to 89 points at the last follow up evaluation, this improvement was significant. A low percentage of radiological demarcation at the bone-cement interface around the acetabular sockets was observed in the immediate postoperative and the last follow up radiographs

Deficiência femuralfocal proximal: relato de dois casos / Proximal femoral focal deficiency: two case reports

A Deficiência Femural Focal Proximal é uma condiçäo rara, que acomete o fêmur e o acetábulo, estando associada a um grande número de malformaçöes. Este artigo descreve dois casos em recém-natos e revisa os aspectos clínicos e diagnósticos mais relevantes. Os dois pacientes foram etendidos logo após o nascimento no Centro Cirúrgico Obstétrico do Hospital Universitário Evangélico de Curitiba, onde as malformaçöes foram inicialmente observadas. O primeiro paciente apresentava a DFFP de forma isolada; já o segundo possuía, também, pé torto congênito bilateral e luxaçäo coxo-femural congênita bilateral. Contradizendo a incidência encontrada na literatura, os dois pacientes nasceram no mesmo dia e continuam em acompanhamento ambulatorial em nosso serviço

Osteotomía pélvica de Chiari e intertrocantérea en un mismo tiempo quirúrgico, para pacientes con displasia de la cadera / Double pelvis Chiari and intertrochanteric osteotomy in one operating time for patients who has dip dysplasia

Debido a los pobres resultados obtenidos con el reemplazo articular en pacientes jóvenes, especialmente con soporte óseo deficiente tanto en acetábulo como en fémur por displasia, proponemos una solución "Biológica" de centraje y cobertura. Ocho pacientes con artrosis secundaria displasia de la cadera, fueron tratados quirúrgicamente con una osteotomía varizante y derrotadora intertrocantérea y una osteotomía del iliaco tipo Chiari en un mismo tiempo quirúrgico, con edad de 15 a 43 años, y con un seguimiento inicial de 3 a 17 meses. El dolor fue el principal síntoma en todos los pacientes, la indicación de la cirugía se basó en la severidad de la incongruencia articular desde el punto de vista clínico y radiográfico así como el grado de artrosis. El promedio de valoración preoperatoria en la escala de Merle D'Aubigné el dolor estaba en 4 y la movilidad y la marcha en 3.8 y 3.5 respectivamente y con grado de incongruencia III y IV. En la evaluación postoperatoria final, se logró un promedio de 5.7 en dolor y de 4.8 en marcha y movilidad, se corrigió la incongruencia en grado II en promedio y radiográficamente se observó regresión en la artrosis en el 62.5 por ciento de los casos. El ángulo CE de Wiberg fue 8.7º preoperatoriamente y se llevó hasta 24º promedio postoperatorio, el ángulo de Sharp tuvo un valor promedio de 49.1º y se logró corregir hasta 43.1º promedio postoperatorio. Los resultados preliminares de este tipo de cirugía como solución "Biológica" son alentadores sobre todo en los casos de displasia grado II y III. Conclusión. Es un tratamiento quirúrgico adecuado ya que provoca regresión de los cambios degenerativos, al mejorar el rango de movilidad y patrón de marcha

Estudo tomográfico dos ângulos de anteversão, versão acetabular e índice acetabular axial de crianças / Computed axial acetabular index, acetabular version and acetabular anteversion study in children

Tomografias axiais computadorizadas de quadris normais de 50 pacientes portadores de patologias diversas foram estudadas com o intuito de mensurar os valores angulares do índice acetabular axial, a versão acetabular e a anteversão acetabular. Trinta eram do sexo masculino e 20 do feminino e a idade variou dos seis meses aos 13 anos, numa média de 6,2 anos. Trinta e oito pacientes eram brancos e 12 não brancos. A análise estatística mostrou que não havia diferença significante entre os lados, sexo e cor, permitindo avaliar os ângulos de cem articulações coxofemorais. As médias dos ângulos estudados foram apresentadas em faixas etárias de < 2; 2-3; 4-5; 6-7; 8-9; 10-11 e 12-13 anos e a média geral dos índice acetabular axial, versão acetabular e anteversão acetabular foi de 109,75°, 5,03°, e 13,76°, respectivamente. Os autores concluem que, com o crescimento, os valores dos ângulos vão diminuindo, mostrando que a articulação do quadril se torna mais estável e a cabeça centra-se melhor no acetábulo. A versão acetabular às vezes torna-se negativa (retroversão), mas no decorrer de todo o crescimento o quadril sempre se dirige anteriormente. Os valores da anteversão acetabular foram os únicos que mostraram tendência ascendente, mas sem significado estatístico.

Proximal femoral focal deficiency (PFFD).

A 1-year-old child with proximal femoral focal deficiency (PFFD) is presented. The clinical spectrum and associated abnormalities is described and the diagnosis and management of this entity is discussed.

Avaliaçäo das discrepâncias de comprimento dos membros inferiores / Evaluation of leg lenght discrepancies

Os laudos radiográficos sao, muitas vezes, incompatíveis com a discrepância clínica dos membros inferiores, por tomar-se como referencial proximal o extremo mais cranial do fêmur. O equívoco é mais freqüente nas afecçöes em que existe comprometimento da relaçäo femoroacetabular. Os autores propöem que, nessas eventualidades, o balizamento escanométrico proximal se faça a partir dos limites inferiores das articulaçöes sacroilíacas. O resultado obtido é muito mais condizente com a diferença clínica e funcional observada no paciente, demonstrando, assim, que podem ser evitadas as distorçöes mais comuns nas avaliaçoes das discrepâncias dos membros inferiores.

Osteossíntese com dois parafusos no tratatamento das fraturas do colo do fêmur / Osteosynthesis with two screws in the treatment of fractures of the femoral neck

É realizada uma análise de 97 pacientes com fraturas do colo do fêmur, tipos I, II e III, segundo a classificaçäo de Garden, submetidos a osteossíntese com dois parafusos tipo Leôncio Fernandez, entre 1980 e 1987. Os autores apresentam os resultados obtidos e as diversas alternativas em relaçäo ao tratamento e prognóstico.

The Reaction of the Acetabular Articular Cartilage to Bipolar Hemiarthroplasty

An evaluation of the acetabular cartilage was performed grossly and histologically in a patient who had a bipolar hemiarthroploasty, which had served satisfactorily for 2 years until the femoral prosthetic head had been separated from the acetabular assembly due to creep deformation of the inner bearing polyethylene cup. This study indicates that the double-bearing bipolar prosthesis dose not necessarily have an advantage over the classical single-piece prosthesis in the prevention of acetabular cartilage wear.