ACETABULAR RECONSTRUCTION IN PAPROSKY TYPE III DEFECTS.

Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.

Objetivos: A deficiência pélvica severa apresenta um problema difícil na artroplastia do quadril. Especificamente, os objetivos são restaurar o estoque ósseo pélvico, colocar o componente acetabular na posição anatômica correta e otimizar a estabilidade da articulação. Atualmente, existem muitas técnicas cirúrgicas para a cirurgia de revisão protética em defeitos do complexo acetabular, mas não há consenso sobre o melhor tratamento. Os objetivos deste trabalho são revisar casos de médio prazo operados por apresentar defeito ósseo grave (Paprosky tipo III) tratado com aloenxerto ósseo e gaiola anelar Bursch - Schneider anti protusio (BSAC). Métodos: Foi realizada uma revisão retrospectiva consecutiva das primeiras 23 reconstruções acetabulares complexas realizadas entre 2006 e 2011. Esta série inclui a curva de aprendizado do procedimento e tem um acompanhamento mínimo de 5 anos. Conclusão: Em conclusão, nosso estudo confirma a eficácia do uso de aloenxerto morselado congelado combinado com um anel de metal tipo BSAC durante a reconstrução acetabular. É necessário recuperar o centro de rotação do quadril em sua localização anatômica para o sucesso a longo prazo. Em casos de soltura maciça, o centro anatómico de rotação só pode ser restaurado pela reconstrução da densidade óssea usando um enxerto protegido por um anel que melhora a centralização da cabeça. Nível de Evidência tipo IV, Série de Casos.

Short femoral stem in total hip arthroplasty: stable fixation and low complication rates in elderly patients.

BACKGROUND: We present the result of our experience in using a short femoral stem in elderly patients (>70 years of age) compared to patients younger than 70 years. METHODS: Data were prospectively collected on 138 patients who underwent 148 primary total hip arthroplasty (THA), with a conservative short stem between November 2010 and June 2014. The cohort was divided into 2 groups: the study group (group 1) comprised 57 patients (60 THA) over 70 years of age at the time of surgery, with a mean age of 75.4 years (range 70-87 years) and a mean follow-up of 26.7 months (range 9-48 months). The control group (group 2) comprised 81patients (88 THA) less than 70 years of age with a mean age of 57.4 years (range 33-69 years) and a mean follow-up of 27.3 months (range 9-54 months). Hip function in the 2 groups was compared preoperatively and postoperatively using the Merle D'Aubigne hip score (MD) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. RESULTS: At the latest follow-up, 1 calcar fracture was reported in a 54-year-old patient in the control group, which required fixation with a screw and had a favourable outcome. No cases of clinical or radiographic loosening were reported.Clinical results showed no statistically significant differences between the 2 groups. CONCLUSIONS: The use of the GTS conservative short stem in patients over 70 years old has shown very good results and low complication rates, comparable to those for patients younger than 70 years.

Early clinical results of a new conservative hip stem.

Conservative stems conserve a larger amount of bone, and due to their biomechanical effect, they allow higher compression forces on the lateral column of the femur and reduce stress shielding. Since they conserve metaphyseal bone, short stems allow the use of conventional stems when revision surgery becomes necessary. The authors present the early results of a new bone conserving stem GTS (Biomet). A total of 80 patients (55 men and 25 women) were enroled in this prospective study and received 81 GTS stem (1 bilateral). Their mean age was 64.8 years (range 43-78) at the time of surgery. The mean follow-up was 16 months (range 6-24 month). The clinical assessment was performed by a single surgeon using the Merle d'Aubigné scale; radiographic complications were described. There was one calcar fracture, which required a fixation with a screw. No cases of clinical or radiological loosening were reported. GTS Conservative hip arthroplasty stem has proven to be an excellent implant for femoral hip replacement, with expectations that it may exceed the durability of other types of implants without harming the femoral diaphysis. This may facilitate eventual stem revision and give surgeons the opportunity of using a standard primary implant.

Tratamiento quirúrgico de la luxación recidivante del hombro con la técnica de Bankart / Surgical treatment for recurrent dislocation of the shoulder with the Bankart procedure

El éxito del tratamiento de la inestabilidad anterior del hombro requiere un equilibrio entre el restaurar una estabilidad de la articulación y su normal movilidad. Escoger el tratamiento puede personalizarse en función de las caracteristicas del paciente como su trabajo habitual, actividad deportiva, así como el grado de inestabilidad del hombro. A pesar de las diferentes ideas, la existencia de la lesión de Bankart es sin lugar a duda la mas importante en estas inestabilidades. El tratamiento debe permitir reconocer y resolver la inestabilidad durante el acto operatorio. Gran cantidad de técnicas han sido propuestas para el tratamiento de la inestabilidad anterior del hombro, sin embargo, la estabilización abierta sigue siendo la que mejor opción especialmente en las inestabilidades severas y deportistas. Presentamos un estudio retrospectivo de 33 pacientes que presentaban una inestabilidad anterior escápalo- humeral producida por un traumatismo deportivo. El diagnóstico se realizó mediante la anamnesis y exploración física acompañada de radiología simple y resonancia magnética. Todos los pacientes ful:ron intervenidos mediante la técnica de Bankart a cielo abierto, utilizando los anc1ajes metálicos para la reparación del complejo cápsulo-labrum, y la cápsula fue suturada de manera que la parte infero-externa fue suturada en la porción medial superior, a modo de retensado capsular. Se trataban de 33 pacientes, 29 varones y 4 mujeres, con una edad media de 24 años. Seguimiento medio de los pacientes fue de 31 meses. El resultado final según la escala de Rowe fue excelente o bueno en 31 pacientes (93,9%) regular en 1 caso (3,03%) y malo en un caso. La movilidad fue completa en 28 pacientes pero hubo 5 casos que presentaron una disminución de la rotación externa, con una media de perdida de 8°Todos los pacientes volvieron a su actividad deportiva al finalizar el tratamiento. Hubo un caso de recidiva de la luxación y un caso en el que se comprobó una subluxación, en ambos casos dejaron la práctica deportiva

Successful treatment of anterior instability of the shoulder requires a balance between restoringjoint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis ofthe patient's occupation and level of participation in sports, as well as on the degree of instability of the shoulder. Despite discussions to the contrary, there is no single "essential lesion," as proposed by Bankart, that is responsible for recurrent anterior shoulder instability, although the Bankart lesion is by far the most important. The choice of operative treatment must be tailored to correct the abnormality that is identified at the time of surgery. A variety of techniques have been developed for the treatment of anterior shoulder instability; however, open stabilization remains the standard, especially for severe instabilities, revision procedures, and for athletes who participate in contact sports. We present a retrospective study of 33 patients with traumatic anterior instability of the shoulder produced by sport injury. The diagnostic was made with the medical exploration and XR and MR. All patients underwent surgerywith the open Bankart technique using sutures supported on bone anchors with metal hooks. The series consisted 29 men and 4 women with a mean age of 24 years. The mean postoperative followup was 23.4 months evaluated on the Rowe scale. The results were excellent or good in 31 patients, fair in 1, and poor in 1. Complete mobility was recovered in 28 patients, but external rotation was limited in 5 patients, with a mean loss of 8°. AII patients carne back sport finished the treatment There were l case of recurrent dislocation and another case of subluxation, Both 2 cases leave de sport practical