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1.
Orthop Surg ; 12(6): 2004-2012, 2020 Dec.
Article in English | MEDLINE | ID: mdl-33099883

ABSTRACT

The aim of the present study was to evaluate the dislocation rate and the risk factors leading to instability after primary and revision total hip replacement arthroplasty (THRA) with constrained acetabular liners (CAL), as well as treatment strategies for prevention of dislocation. From 1999 to 2017, drawing on two institutions' THRA registries, we retrospectively identified 46 THRA cases using a CAL that had been followed up for a minimum of 4 years. The patients comprised 39 women and 7 men, with an average age of 69.1 years (age range, 41-98). Of the 46 patients, CAL were used in 12 patients for prevention of dislocation in primary THRA and in 34 patients for treatment of recurrent dislocation after primary THRA. Clinical and radiological evaluation were performed. We evaluated the failure rate of CAL as well as the risk factors. The 12 patients who used CAL for prevention of dislocation in primary THRA had no dislocation. However, 12 (35%) of the 34 hips had a dislocation after use of CAL in revision THRA. Patients with an abductor muscle weakness grade of ≤3 had a higher rate of dislocation than those with a grade of ≥4 (grade 1; likelihood ratio = ∞, grade 2; likelihood ratio = 1.83, grade 3; likelihood ratio = 1.05, grade 4; likelihood ratio = 0.46, and grade 5; likelihood ratio = 0). The group of primary THRA with CAL had no dislocations, and this is a proper way for prevention of dislocation in high-risk patients. The group of revision THRA with CAL had a high dislocation rate (35%). Abductor muscle weakness below grade 3 was a risk factor for failure of CAL for hip dislocation. We recommend treating patients with recurrent dislocations with the presence of abductor muscle weakness below grade 3 with not only THRA using CAL but also applying additional abductor muscle reconstruction to reduce the risk of dislocation.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Hip Dislocation/etiology , Hip Dislocation/surgery , Hip Prosthesis , Prosthesis Design , Prosthesis Failure , Reoperation/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
2.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3989-3996, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31375876

ABSTRACT

PURPOSE: To evaluate clinical and radiological outcomes of medial row anchor insertion between 90° or 45° (deadman) angle in the suture-bridge rotator cuff repair of medium-to-large rotator cuff tears. METHODS: This retrospective analysis included 113 consecutive patients undergoing arthroscopic suture-bridge repair for medium-to-large rotator cuff tears (mean tear size: 2.8 × 2.3 cm) between 2010 and 2013. The patients were divided into two groups: group I (53 patients) and group II (60 patients) involving 90° and 45° medial row anchors, respectively. The conventional lateral row anchors were inserted in the suture-bridge repair. The clinical outcomes at 2 years and radiological outcomes including re-tear or footprint coverage (anteroposterior length and mediolateral width) of the repaired tendon using postoperative MRI were evaluated. RESULTS: Clinical outcome scores were significantly improved in both groups. However, Group I (90° anchor insertion group) showed better clinical scores without the difference of range of motion. The postoperative MRI revealed enlarged footprint coverage with 90° medial row anchor. The repaired footprint cuff size (mediolateral width) in the coronal plane MRI showed a statistically significant difference (45°: 19 mm vs. 90°: 24 mm) (p < 0.05). CONCLUSIONS: Enhanced clinical outcomes and additional anatomical footprint coverage (coronal width of repaired tendon) in the suture-bridge repair are obtained with the 90° medial row anchors compared with the 45° medial row anchors. These findings would guide clinical application of 90° medial row anchor insertion for further medialization in the medium-to-large rotator cuff tears. LEVEL OF EVIDENCE: Level III (retrospective comparative trial).


Subject(s)
Arthroscopy/methods , Rotator Cuff Injuries/surgery , Suture Anchors , Suture Techniques , Aged , Female , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Rotator Cuff Injuries/diagnostic imaging
3.
Knee Surg Sports Traumatol Arthrosc ; 27(10): 3327-3333, 2019 Oct.
Article in English | MEDLINE | ID: mdl-30659313

ABSTRACT

PURPOSE: To evaluate the effectiveness of immediate arthroscopy and clinical outcomes following open reduction and internal fixation (ORIF) of tibial plateau fractures. METHODS: Sixty patients (36 men and 24 women, median age 56 (20-78) years) were divided into Group I (ORIF only: 26 patients, median age 58 (25-78) years) or Group II (ORIF with immediate arthroscopy: 34 patients, median age 55 (20-75) years) in tibial plateau fractures (Schatzker Type II-VI fractures). In the first part of this study, ORIF only was performed without arthroscopic treatment. In the second part, ORIF with immediate arthroscopic examination and treatment was performed. Clinical outcomes, utilizing range of motion (ROM), International Knee Documentation Committee (IKDC) score and hospital for special knee score (HSS) were assessed. RESULTS: At the final follow-up, HSS score was 81 ± 11 points in Group I and 83 ± 9 points in Group II. The IKDC score was 85 ± 8 points in Group I and 86 ± 6 points in Group II. In Group II, concomitant intra-articular lesions in 10 patients (29%) were found and treated simultaneously. However, there were no significant differences in clinical scores or ROM between the two groups. CONCLUSION: Immediate arthroscopy following ORIF for tibial plateau fracture is an effective procedure that provides accurate information for fracture reduction, leading to immediate treatment of concomitant intra-articular lesions without complications. LEVEL OF EVIDENCE: III.


Subject(s)
Arthroscopy/methods , Fracture Fixation, Internal/methods , Knee Injuries/diagnosis , Open Fracture Reduction/methods , Tibial Fractures/surgery , Adult , Aged , Early Diagnosis , Female , Humans , Knee Injuries/complications , Knee Injuries/diagnostic imaging , Knee Injuries/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Range of Motion, Articular , Tibial Fractures/complications , Tibial Fractures/diagnostic imaging , Tibial Fractures/physiopathology , Time-to-Treatment , Tomography, X-Ray Computed
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