RESUMO
Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons' cup orientation accuracy was not seen to improve significantly with experience.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Cirurgiões Ortopédicos , Cirurgiões , Acetábulo/cirurgia , HumanosRESUMO
INTRODUCTION: There is widespread trend in total hip replacement to limit soft tissue damage. New approaches that respect the capsule and ligaments has been recently reported. The potential advantages of this approach is to improve short-term results in terms of stability, pain, length of stay, transfusions and complications. METHODS: From October 2015 to March 2016 the two senior authors performed 21 hips using the Superpath® technique, the measured variables included age, sex, operative time, acetabular inclination, pain assessment using visual analogue scale at 24 hours, need for transfusion, length of stay and complications. Surgical technique is described. RESULTS: 10 women and 11 men with a mean age of 56.57 (35-74) years. Average operating time was 102.85 (80-130) minutes. The mean acetabular inclination was 44.05 (26-60) degrees. The visual analogue scale (VAS) at 24 hours of the procedure was 2.38, standard deviation (SD) 0.9. The length of stay was on average 4.04 days 1.4 days shorter when compared with a cohort of patients treated using standard posterolateral. All patients were discharged to home. Two patients required transfusion, and in one patient with a calcar crack, crutches for 8 weeks were instructed. No patients were readmitted. DISCUSSION: The new generation of hip approaches have a strong anatomical basis, hip capsule preservation is a revolutionary concept, it ensures anatomical restoration, length and offset near to native joint. The Superpath® potentially minimises morbidity, reducing transfusion rates, allowing rapid recovery, shortening hospital stay and could save a significant cost to the healthcare system.
Assuntos
Acetábulo/cirurgia , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril/métodos , Osteoartrite/cirurgia , Adulto , Idoso , Feminino , Fluoroscopia/métodos , Seguimentos , Humanos , Cápsula Articular/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Duração da Cirurgia , Osteoartrite/diagnóstico , Medição da Dor/métodos , Posicionamento do Paciente/métodos , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Lesões dos Tecidos Moles/prevenção & controle , Resultado do TratamentoRESUMO
La pseudoartrosis de calcáneo es excepcional. La incidencia es del 1,3 por ciento de todas las fracturas intraarticulares. Se relaciona con fracturas intraarticulares tratadas conservadoramente, diabetes mellitus, tabaquismo y fracturas abiertas. Presentamos un caso de pseudoartrosis de calcáneo, secuela de fractura de luxación abierta en el contexto de un pie catastrófico(AU)
Calcaneal pseudoarthrosis is rare and its incidence accounts for 1.3 percent of all the intra-articular fractures. It is associated to intra-articular fractures treated with conservative methods, diabetes mellitus, smoking and open fractures. This is a calcaneal pseudoarthrosis case as a sequel of open dislocation fracture in a catastrophic foot injure(AU)
La pseudarthrose du calcanéum est une affection assez rare. Son incidence est 1.3 pourcent de toutes les fractures interarticulaires. Elle est associée aux fractures interarticulaires traitées de façon conservatrice, au diabète sucré, au tabagisme, et aux fractures ouvertes. Un cas de pseudarthrose de calcanéum, séquelle d'une fracture-luxation ouverte du pied après accident de route, est présenté(AU)
