Cirugía de prótesis de cadera en el adulto con enfermedad de Legg-Calvé-Perthes / Total hip arthroplasty in adults with Legg-Calvé-Perthes disease

Objetivos: Revisar las cirugías de prótesis totales de cadera realizadas en nuestro hospital, determinar el origen de la artrosis e identificar cuántas se colocaron por coxartrosis secundarias a enfermedad de Legg-Calvé-Perthes. Materiales y Métodos: Se realizó un estudio retrospectivo en el que se revisaron todas las cirugías de prótesis totales de cadera desde 2008 hasta diciembre de 2021. Se evaluaron las radiografías prequirúrgicas para determinar la etiología de la artrosis, y se consideraron variables, como lateralidad, sexo y edad en el momento de la intervención. Resultados: Se revisaron 1103 caderas en 935 pacientes. El 81% correspondía a coxartrosis primaria. En 11 caderas de 10 pacientes (1%), se detectó coxartrosis secundaria a la enfermedad de Legg-Calvé-Perthes. La media de la edad de estos pacientes era de 61 años. Conclusiones: Hay evidencia de que las alteraciones del crecimiento de la fisis femoral proximal o el sobrecrecimiento del trocánter mayor, propias de la enfermedad de Legg-Calvé-Perthes, pueden contribuir a la aparición de un choque femoroacetabular, con su consiguiente coxartrosis precoz. Es posible que algunas "mal clasificadas" coxartrosis primarias fueran identificadas así porque no existía otro dato sugerente de coxartrosis secundarias, y escondieran otra etiología evolucionada. Asimismo, proponemos el seguimiento del paciente joven con enfermedad de Legg-Calvé-Perthes, más allá del final del crecimiento, para identificar el choque femoroacetabular en sus inicios y poder ofrecer opciones terapéuticas artroscópicas. Nivel de Evidencia: III

Objectives: To review the number of total hip replacements (THA) performed in our hospital, determine their aetiology and identify how many of them were performed for hip osteoarthritis secondary to Legg-Calvé-Perthes disease (LCPD). Materials and Methods: We conducted a retrospective study reviewing all THA surgeries from 2008 to December 2021. We studied the pre-operative radiographs, determining the aetiology of the osteoarthritis, laterality, sex and age of the patient at the time of surgery. Results: We reviewed a total of 1103 hips in 935 patients. Primary hip osteoarthritis accounted for 81% of the cases. We gathered a total of 11 hips from 10 individuals (1%), with a mean age of 61 years, for hip osteoarthritis secondary to LCPD. Conclusions:There is evidence that femoro-acetabular impingement (FAI), which results in early secondary hip osteoarthritis, may be influenced by changes in the growth of the proximal femoral physis or overgrowth of the greater trochanter, which are characteristics of LCPD. We believe that certain cases of "misclassified" primary hip osteoarthritis may have been incorrectly identified since no additional information was found to support the diagnosis of secondary hip osteoarthritis, hiding the potential of an alternate, evolved aetiology. Furthermore, we suggest monitoring young patients with LCPD after their growth is complete in order to detect early FAI and provide arthroscopic therapeutic options. Level of Evidence: III

Variations in the position of the aorta and vertebral safe zones in supine, prone, and lateral decubitus for adolescent idiopathic scoliosis.

PURPOSE: Analyze the modifications in the "safe zones" of T4-L4 vertebral bodies relative to aorta according to patient positioning, as well as in the relationship between the aorta and the vertebrae. METHODS: Patients with adolescent idiopathic scoliosis who underwent surgical treatment during 2017 were included. Preoperative whole spine MRI in supine, prone, and LD positions was performed. The safe zone right (SZR) was defined as the angle formed between X-axis (0º) and a line connecting the origin and the edge of the aorta, and the safe zone left (SZL) was the angle between the edge of the aorta to 180º (X-axis). RESULTS: A total of 21 patients were studied, median age was 15.2 years, and 71.4% were female. The mean SZR lied from 0°-86.1º at T4 to 0°-76.9º at L4 in supine, from 0°-84.05º at T4 to 0º-78.5º at L4 in prone, and from 0° to 91.75º at T4 to 0°-80.4º at L4 in LD. While the mean SZL was located from 155.4º-180º at T4 to 107.9º-180º at L4 in supine, from 134°-180° at T4 to 103.9°-180° at L4 in prone, and from 143.8º-180º at T4 to 106º-180º at L4 in LD. Statistically significant differences were found almost at all levels when comparing supine versus prone and LD. CONCLUSIONS: Patient positioning during spinal surgery significantly modifies T4-L4 vertebral safe zones relative to aorta. These variations should be taken into account when analyzing an MRI performed in supine if the patient is undergoing surgery in a different position, to avoid vascular-related injuries.