RESUMEN
Tibial bone defect remains a challenge in revision knee arthroplasty. The present innovative technique combines structural allograft and tantalum metaphyseal cone for treatment of AORI stage 2A and 2B (uncontained peripheral metaphyseal) tibial defect. The aim is to reconstitute bone stock and enhance allograft osseointegration, while limiting stress to the allograft by implanting the metaphyseal cone through the allograft and the original bone. LEVEL OF EVIDENCE: V (expert opinion).
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Tantalio , Reoperación/métodos , Tibia/diagnóstico por imagen , Tibia/cirugía , Aloinjertos/cirugía , Diseño de Prótesis , Articulación de la Rodilla/cirugíaRESUMEN
INTRODUCTION: Dual-mobility (DM) acetabular implants have been used in revision total hip arthroplasty (THA) to prevent postoperative instability, with excellent mid-term survivorship. However, few comparative studies assessed the long-term outcomes of DM implants used in Kerboull-type reinforcement ring constructs for acetabular revision. The present study aimed to compare long-term survivorship, dislocation rates and clinical outcome between DM acetabular implants and conventional single-bearing (SB) implants when cemented in a reinforcement ring. HYPOTHESIS: Dual-mobility implants are associated with equivalent survivorship and lower dislocation rates than SB implants. MATERIAL AND METHODS: A retrospective study included 60 revision THAs for aseptic loosening using a Kerboull-type reinforcement ring, and finally included 2 groups of 23 patients with either DM or SB cemented acetabular implants after matching for age, gender, BMI and preoperative Harris hip score. Mean follow-up was 10 years (range, 6-14 years). Acetabular implant survivorship, dislocation rate and radiographic failure incidence (>5mm migration, progressive radiolucency, graft non-integration, reinforcement ring breakage) were compared between the two groups. Clinical outcomes used the Harris hip score, the Postel-Merle d'Aubigné score and the Parker score. RESULTS: Survivorship free of aseptic acetabular re-revision was 89% at 10 years, with no significant difference between DM and SB (91% and 86%, respectively; p=0.54). Single-bearing implants showed a hazard ratio for dislocation of 6.7 (95% CI, 1.5-29.6; p=0.01) compared to DM implants. There were no significant differences in radiologic failure (10-year survivorship 72% and 64%, respectively; p=0.88) or functional scores. DISCUSSION: The present study confirmed the impact of dual-mobility implants in reducing long-term dislocation risk when used in Kerboull-type reinforcement ring constructs for acetabular aseptic revision, with no increased risk of re-revision compared to conventional single-bearing implants. LEVEL OF EVIDENCE: III, comparative retrospective study.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Luxaciones Articulares , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Seguimiento , Prótesis de Cadera/efectos adversos , Humanos , Luxaciones Articulares/cirugía , Diseño de Prótesis , Falla de Prótesis , Reoperación/efectos adversos , Estudios Retrospectivos , SupervivenciaRESUMEN
BACKGROUND: The objective was to assess the predictive performance of different intravascular contrast extravasation (ICE) characteristics for need for pelvic transarterial embolization (TAE) to determine the risk factors of false positives. METHODS: A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture were included. Pelvic ICE characteristics on computed tomography (CT) scan were studied: arterial (aSICE), portal surface (pSICE), and extension (exSICE) anatomic relationships. The overall predictive performance of ICE surfaces for pelvic TAE was analyzed using receiver operating characteristic curves. The analysis focused on risk factors for false positives. RESULTS: Among 311 severe trauma patients with pelvic ring fracture (mean age, 42 ± 19 years; mean Injury Severity Score, 27 ± 19), 94 (30%) had at least one pelvic ICE on the initial CT scan. Patients requiring pelvic TAE had significantly larger aSICE and pSICE than others (p = 0.001 and p = 0.035, respectively). The overall ability of ICE surfaces to predict pelvic TAE was modest (aSICE area under the receiver operating characteristic curve, 0.76 [95% confidence interval, 0.64-0.90]; p = 0.011) or nonsignificant (pSICE and exSICE). The high-sensitivity threshold was defined as aSICE 20 mm or more. Using this threshold, 76% of patients were false positives. Risk factors for false positives were admission systolic blood pressure of 90 mm Hg or greater (63% vs 20%; p = 0.03) and low transfusion needs (63% vs 10%; p = 0.009), extravasation in contact with complex bone fracture (78% vs 30%; p = 0.008), or the absence of a direct relationship between extravasation and a large retroperitoneal hematoma (100% vs 38%; p < 0.001). CONCLUSION: A significant pelvic ICE during the arterial phase does not guarantee the need for pelvic TAE. Three quarters of patients with aSICE of 20 mm or more did not need pelvic TAE. Several complementary CT scan criteria will help to identify this risk of false positives to determine adequate hemostatic pelvic procedures. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Asunto(s)
Embolización Terapéutica/métodos , Pelvis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/efectos adversos , Heridas no Penetrantes/diagnóstico por imagen , Adulto , Angiografía/métodos , Embolización Terapéutica/estadística & datos numéricos , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Extravasación de Materiales Terapéuticos y Diagnósticos/epidemiología , Reacciones Falso Positivas , Femenino , Fracturas Óseas/diagnóstico por imagen , Hematoma , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Huesos Pélvicos/lesiones , Huesos Pélvicos/patología , Pelvis/irrigación sanguínea , Pelvis/lesiones , Valor Predictivo de las Pruebas , Espacio Retroperitoneal/irrigación sanguínea , Espacio Retroperitoneal/patología , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Centros Traumatológicos , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/terapiaRESUMEN
Total hip arthroplasty is actually one of the most orthopaedic procedures realised to treat a lot of conditions in hip pathology. Complications associated with this operation are well established and reported in the medical literature. Only few cases of intraoperative dislocation of the trial femoral head had been reported; we present a case of intraoperative intrapelvic dislocation of the trial femoral head through the iliopsoas muscle during total hip replacement with a standard posterolateral approach of Moore.
RESUMEN
We present the case of a 64-year-old woman with a subcutaneous vascular leiomyoma in the tarsal tunnel in the ankle. The patient presented with pain of several years' duration in the medial aspect of the ankle in the retromalleolar region corresponding to the tarsal tunnel and associated with a subcutaneous mass. We report the clinical manifestation, the imaging and histopathologic features, and a review of the literature. Vascular leiomyomas are part of the differential diagnosis of painful subcutaneous masses in the lower extremity.