ABSTRACT
INTRODUCTION: Haemophilic pseudotumour (HP) is an encapsulated haematoma in patients with haemophilia (PWH) which has a tendency to progress and produce clinical symptoms related to its anatomical location. AIM: To show the experience of one surgeon who has been using mini-invasive technique to treat pseudotumours of limbs in PWH with and without inhibitors at one centre for 28 years. MATERIALS AND METHODS: Thirty-three patients with 39 HP were treated. All patients had haemophilia A. Twenty-four patients had no inhibitors (72.8%), and 9 had inhibitors (27.2%). The mean follow-up was 16 years (1-25). All patients had x-rays and MRIs. All of them received Buenos Aires protocol as conservative treatment for 6 weeks. MRIs were repeated after 6 weeks' treatment to assess response to treatment. Surgery was performed in patients who did not respond to conservative treatment. RESULTS: After Buenos Aires protocol, four pseudotumours did not shrink (10.24%), 33 (84.61%) shrank, and two (5.12%) healed. Thirty-seven pseudotumours had surgery, 35 pseudotumours (94.59%) healed with minimally invasive treatment, and two did not heal (5.41%). No infection was observed with this treatment. The mortality rate for the series was 0%. CONCLUSION: The minimally invasive treatment of pseudotumours was effective in 95% of the cases and resulted in no mortality in this series after 28 years.
Subject(s)
Extremities/pathology , Hematoma/surgery , Hemophilia A/pathology , Minimally Invasive Surgical Procedures/methods , Adolescent , Adult , Child , Coagulants/administration & dosage , Coagulants/therapeutic use , Conservative Treatment/methods , Extremities/diagnostic imaging , Factor VIIa/administration & dosage , Factor VIIa/therapeutic use , Hematoma/drug therapy , Hemophilia A/complications , Humans , Infusions, Intravenous , Magnetic Resonance Imaging/methods , Middle Aged , Radiography/methods , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/pathology , Treatment Outcome , Young AdultABSTRACT
The posterior dislocation remains one unresolved complication of the posterior approach to the hip joint. In this study, a variation of the posterior hip approach - a partial osteotomy of the greater trochanter - was performed in order to investigate whether it provides better stability to the operated hip joint and reduces the risk of dislocation. We carried out a partial intertrochanteric osteotomy, initially in a cadaveric model and then in 68 patients (30 acute neck of femur fractures and 38 patients with hip osteoarthritis) requiring a total hip replacement. The osteotomised fragment was reattached with wires. All arthroplasties were cemented with Müller acetabular component and Charnley-type stem with a 28-mm interchangeable neck. Intraoperatively, all hips were tested for stability. After the osteosynthesis of the osteotomised fragment, hip dislocation points were increased more than 15% in the flexion and 10% in the internal rotation plane of movement. At one year follow up, no dislocation was observed in the clinical component of the study. This technique was found reliable in providing a stable hip joint.