Is the size of the acetabular bone lesion a predictive factor for failure in revisions of total hip arthroplasty using an impacted allograft?

OBJECTIVE: The aim of this study was to determine the acetabular bone lesion size (in millimeters) from which impacted bone graft failure starts to occur more frequently, through simple anteroposterior hip radiographs, and whether measurement of the defect on simple radiographs maintains the same pattern in inter and intraobserver assessments. METHODS: Thirty-eight anteroposterior pelvic-view radiographs from patients undergoing revision of an acetabular prosthesis were retrospectively analyzed and assessed. In the vertical plane, the bilacrimal line was measured in millimeters from the farthest point found on the bone edge of the acetabular osteolysis to the top edge of the cementation or of the acetabular implant in uncemented cases. The base was taken to be a line perpendicular to bilacrimal line, with the aim of eliminating any pelvic tilt effects. This measurement was named the vertical size of failure. Radiographs produced four years after the operation were analyzed to investigate any failure of the technique. RESULTS: The graft failure rate in the study group was 26.3%. The failures occurred in cases with an initial bone defect larger than 11 mm. No cases with measurements smaller than this evolved with failure of the revision. The highest incidence of graft failure occurred in cases described as advanced according to the "Paprosky" classification. CONCLUSION: Failure of acetabular revision arthroplasty using an impacted graft did not present any statistically significant correlation with the vertical extent of the lesion on simple anteroposterior radiographs, as a predictor of treatment failure.

OBJETIVO: O presente trabalho buscou, através de uma radiografia simples anteroposterior do quadril, quantificar em milímetros a partir de qual tamanho da lesão óssea acetabular ocorre com maior frequência falha do enxerto ósseo impactado e se a medição do defeito nas radiografias simples mantém o mesmo padrão na avaliação inter e intraobservador. MÉTODOS: Foram analisadas e aferidas retrospectivamente 38 radiografias de pacientes submetidos à revisão de prótese acetabular na incidência anteroposterior de bacia, mensurando em milímetros, no plano vertical a linha bilacrimal, a medida entre o ponto mais distante encontrado na borda óssea da osteolise acetabular, com a margem superior da cimentação ou implante acetabular nos casos não cimentados. Tomamos como base uma linha perpendicular a linha bilacrimal com o intuito de eliminar efeitos de inclinação pelvic. Essa medida foi denominada Tamanho Vertical da Falha. Radiografias pós-operatórias com quatro anos foram analisadas para averiguar falha da técnica. RESULTADOS: No grupo estudado observamos 26,3% de falhas do enxerto que ocorreram a partir de 11 mm de tamanho da falha óssea inicial mensurada e que abaixo desse valor nenhum caso evoluiu com falha da revisão. A maior incidência da falha do enxerto ocorreu nos casos avançados segundo a classificação de Paprosky. CONCLUSÃO: A falha na artroplastia de revisão acetabular com enxerto impactado quando relacionado à medida vertical da lesão em radiografia simples anteroposterior do quadril não apresentou significância estatística como fator preditivo de falha do tratamento.

Is the size of the acetabular bone lesion a predictive factor for failure in revisions of total hip arthroplasty using an impacted allograft? / O tamanho da lesão óssea acetabular é fator preditivo para a falha nas revisões de artroplastia total do quadril com enxerto impactado?

ABSTRACT OBJECTIVE: The aim of this study was to determine the acetabular bone lesion size (in millimeters) from which impacted bone graft failure starts to occur more frequently, through simple anteroposterior hip radiographs, and whether measurement of the defect on simple radiographs maintains the same pattern in inter and intraobserver assessments. METHODS: Thirty-eight anteroposterior pelvic-view radiographs from patients undergoing revision of an acetabular prosthesis were retrospectively analyzed and assessed. In the vertical plane, the bilacrimal line was measured in millimeters from the farthest point found on the bone edge of the acetabular osteolysis to the top edge of the cementation or of the acetabular implant in uncemented cases. The base was taken to be a line perpendicular to bilacrimal line, with the aim of eliminating any pelvic tilt effects. This measurement was named the vertical size of failure. Radiographs produced four years after the operation were analyzed to investigate any failure of the technique. RESULTS: The graft failure rate in the study group was 26.3%. The failures occurred in cases with an initial bone defect larger than 11 mm. No cases with measurements smaller than this evolved with failure of the revision. The highest incidence of graft failure occurred in cases described as advanced according to the "Paprosky" classification. CONCLUSION: Failure of acetabular revision arthroplasty using an impacted graft did not present any statistically significant correlation with the vertical extent of the lesion on simple anteroposterior radiographs, as a predictor of treatment failure.

RESUMO OBJETIVO: O presente trabalho buscou, através de uma radiografia simples anteroposterior do quadril, quantificar em milímetros a partir de qual tamanho da lesão óssea acetabular ocorre com maior frequência falha do enxerto ósseo impactado e se a medição do defeito nas radiografias simples mantém o mesmo padrão na avaliação inter e intraobservador. MÉTODOS: Foram analisadas e aferidas retrospectivamente 38 radiografias de pacientes submetidos à revisão de prótese acetabular na incidência anteroposterior de bacia, mensurando em milímetros, no plano vertical a linha bilacrimal, a medida entre o ponto mais distante encontrado na borda óssea da osteolise acetabular, com a margem superior da cimentação ou implante acetabular nos casos não cimentados. Tomamos como base uma linha perpendicular a linha bilacrimal com o intuito de eliminar efeitos de inclinação pelvic. Essa medida foi denominada Tamanho Vertical da Falha. Radiografias pós-operatórias com quatro anos foram analisadas para averiguar falha da técnica. RESULTADOS: No grupo estudado observamos 26,3% de falhas do enxerto que ocorreram a partir de 11 mm de tamanho da falha óssea inicial mensurada e que abaixo desse valor nenhum caso evoluiu com falha da revisão. A maior incidência da falha do enxerto ocorreu nos casos avançados segundo a classificação de Paprosky. CONCLUSÃO: A falha na artroplastia de revisão acetabular com enxerto impactado quando relacionado à medida vertical da lesão em radiografia simples anteroposterior do quadril não apresentou significância estatística como fator preditivo de falha do tratamento.

An Unusual Metallic Foreign Body inside the Knee Medial Femoral Condyle.

Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms.

Tertiary survey in trauma patients: avoiding neglected injuries.

INTRODUCTION: Medical personnel in trauma centres in several countries have realised that undiagnosed injuries are common and are now focussing their attention on reducing the incidence of these injuries. Tertiary survey is a simple and easy approach to address the issue of undiagnosed injuries in trauma patients. Tertiary survey consists of reevaluating patients 24 hours after admission by means of an anamnesis protocol, physical examination, review of complementary tests and request for new tests when necessary. OBJECTIVE: To show the importance of tertiary survey in trauma patients for diagnosing injuries undetected at the time of initial survey. METHODS: A standardised protocol was used to perform a prospective observational study with patients admitted through the emergency department, Department of Orthopaedics and Trauma, Santa Casa de São Paulo. The patients were reevaluated 24 hours after admission or after recovering consciousness. New physical examinations were performed, tests performed on admission were reassessed and new tests were requested, when necessary. RESULTS: Between February 2012 and February 2013, 526 patients were evaluated, 81 (15.4%) were polytraumatised, and 445 (84.6%) had low-energy trauma. A total of 57 new injuries were diagnosed in 40 patients, 61.4% of which affected the lower limb. Diagnosis of 11 new injuries (19.3%) resulted in changes in procedure. CONCLUSION: The application of the protocol for tertiary survey proved to be easy, inexpensive and beneficial to patients (particularly polytraumatised patients) because it enabled identification of important injuries that were not detected on admission in a large group of patients.