Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review.

Background: The acetabular labrum plays a major role in hip function and stability. The gold standard treatment for labral tears is labral repair, but in cases where tissue is not amenable to repair, reconstruction has been demonstrated to provide superior outcomes compared to debridement. Many types of grafts have been used for reconstruction with good to excellent outcomes. Autograft options include iliotibial band (ITB), semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Questions/Purposes: As allografts are not always readily available and have some inherent disadvantages, the aims of this systematic review were to assess (1) indications for labral reconstruction and (2) summarize outcomes, complications, and reoperation rates after arthroscopic labral reconstruction with autografts. Methods: A systematic review of the literature was performed using six databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar) to identify studies reporting outcomes for arthroscopic labral reconstruction utilizing autografts, with a minimum follow-up of 1 year. Study design, patient demographics, autograft choice, complications, donor site morbidity, reoperation rates, conversion to arthroplasty, and patient reported outcomes were extracted and reported. Results: Seven studies were identified for inclusion with a total of 402 patients (173 females, age range 16-72, follow-up range 12-120 months). The most commonly reported functional outcome score was the modified Harris Hip Score (mHHS), which was reported in six of seven studies. Preoperative mHHS ranged from 56 to 67.3 and improved postoperatively to a range of 81.4-97.8. Conversion to total hip arthroplasty and reoperation rates ranged from 0 to 13.2% and 0 to 11%, respectively. The most common indication for labral reconstruction was an irreparable labrum. Autografts utilized included ITB, hamstring tendons, indirect head of rectus femoris, and capsular tissue. Conclusions: Arthroscopic autograft reconstruction of the acetabular labrum results in significant improvement in the short- and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury.

Reverse Microfracture of the Hip Acetabulum: A Technique for the Wave Lesion.

The long-term efficacy of the treatment of chondral lesions is very important to prevent hip osteoarthritis. Microfracture, autologous chondrocyte transplantation, and direct chondral repair, among others, are techniques that have shown good results in some cases. We propose a technique to treat wave lesions through reverse microfracture, with bubble decompression and adherence of the natural scar from the detached cartilage.

Aseptic loosening rate of the Mayo femoral stem with medium-term follow up.

The aseptic loosening rate of the Mayo hip prosthesis femoral stem was determined in a 44 patient (52 hips) series, by comparing preoperative and postoperative clinical and radiographic parameters, over a minimal 5-year postoperative period. Loosening was obvious before five years in four hips (7.6%), while the stem was considered stable in the remaining 48 hips over a mean 6.1 year period, therefore accounting for a 92.3% Kaplan-Meier survival rate. We conclude that the aseptic loosening rate is too high for the Mayo hip prosthesis femoral stem, as compared to literature data concerning the non-conservative stems.

Does trochanteric transfer eliminate the Trendelenburg sign in adults?

BACKGROUND: Premature closure of the proximal femoral growth plate results in coxa brevis, which usually is associated with insufficiency of the hip abductors. Distal and lateral transfer of the greater trochanter sometimes is recommended to correct this problem. Most of what is known arises from studies of children and adolescents. QUESTIONS/PURPOSES: We asked whether this procedure in adults with coxa brevis would eliminate hip abductor insufficiency and would improve their hip function based on the Harris hip score (HHS). PATIENTS AND METHODS: We prospectively followed 11 patients, aged 19 to 55 years (mean, 40 years) who had distal and lateral trochanteric transfer. All patients had pain and a positive Trendelenburg test before surgery. This test was performed at the latest followup by three observers and the interobserver reliability was determined by the kappa coefficient. The HHS was obtained before surgery and at the latest followup. The minimum followup was 25 months (mean, 52 months; range, 25-77 months). RESULTS: Insufficiency of the hip abductors was eliminated in seven (according to two observers) and eight (according to one observer) of the 11 patients after surgery; the kappa coefficient ranged from 0.79 to 1.0. The mean HHS improved from 64 points preoperatively to 76 points at the final followup. The two patients with preexisting severe osteoarthritis of the hip had the worst final scores and persisted with a positive Trendelenburg test at the final followup. CONCLUSIONS: Distal and lateral transfer of the greater trochanter can eliminate insufficiency of the hip abductors and improve joint function in adult patients with coxa brevis and we believe should be considered for patients without severe osteoarthritis of the hip. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Histology of the regenerate and docking site in bone transport.

INTRODUCTION: Bone transport is based on the principle of distraction osteogenesis described by Ilizarov and is a consecrated method for the treatment of segmental bone defects. One of its most problematic and, paradoxically, least studied aspects is the consolidation of the docking site. We studied histologically the ossification of the docking site and regenerate to determine any difference between them. MATERIALS AND METHODS: Nine adult sheep were submitted to correction of a 1-cm tibial diaphyseal defect using a system of plate-fixed bone transport, with latency period of 1 week and 0.2 mm distraction of the transported segment four times a day. The sheep were divided into three groups of three animals each, according to the observation period of 3, 6 or 12 weeks between the fixation of the transported fragment and the euthanasia. The docking site and the regenerate were studied histologically on sections stained with Masson trichrome. RESULTS: The main mode of docking site ossification was the endochondral one and although intramembranous ossification was also observed simultaneously, it was limited to rare and small foci. In contrast, intramembranous ossification played the major role in the regenerate, with bone formation evolving from the base segment to the target segment. CONCLUSION: The experimental bone transport model proposed in the present study permits us to conclude that there is a clear difference between the ossification of the docking site and of the regenerate.

Damage to the superior gluteal nerve after direct lateral approach to the hip.

The superior gluteal nerve may be damaged during total hip arthroplasty. We prospectively studied 40 patients who had total hip arthroplasties using the Hardinge direct lateral approach to the hip to determine any correlation between superior gluteal nerve damage and abductor function. We used the Trendelenburg test to clinically evaluate abductor function preoperatively and 1 year postoperatively. We evaluated superior gluteal nerve function by electromyography preoperatively and at 4, 8, and 12 weeks until its normalization over a maximum of 24 weeks postoperatively. The Trendelenburg test was positive in 20 patients (50%) preoperatively and in 10 patients (25%) 1 year postoperatively. Seventeen patients (42.5%) had damage to the superior gluteal nerve visible on the first electromyographic evaluation performed 4 weeks postoperatively; three (7.5%) of these patients showed changes when reevaluated 6 months postoperatively; only one of the three patients had a positive Trendelenburg test 1 year postoperatively. Nine of the 37 patients with normal electromyography results had positive Trendelenburg tests. Our results suggest there are frequent electromyographic signs of damage to the superior gluteal nerve using the direct lateral approach to the hip. However, the damage tends to improve spontaneously and does not seem to cause clinically apparent abductor insufficiency.

Estudo da correlação entre o estadiamento clínico e as alterações esqueléticas das metástases ósseas do câncer da mama / Correlation between clinical staging and skeletal alterations of bone metastases in breast cancer patients

Foram estudadas 48 pacientes com câncer da mama e que apresentavam metástases ósseas, com o objetivo de avaliar-se a correlação entre o estadiamento clínico do tumor primário, de acordo com o protocolo do Comitê Americano de Estadiamento do Câncer, e as manifestações esqueléticas das metástases ósseas, tendo sido utilizados como parâmetros para essa avaliação o período de seguimento, o número de metástases, o tipo de lesão, a sua localização e a região do osso acometida. Foi observado correlação entre o estadiamento da lesão primária e o tempo de seguimento, que diminuia à medida que o grau de estadiamento aumentava, não tendo sido observado correlação entre o estadiamento clínico do câncer de mama e os demais parâmetros estudados.