RESUMEN
PURPOSE: in the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. METHODS: two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43-91) years. The median follow-up was 4.2 years (range 1-10.4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre- and postoperatively using patient- and assessor-based outcome scores, as well as radiographic evidence. RESULTS: the mean Knee Society knee and function scores, WOMAC-scores, Oxford-score and VAS pain and satisfaction all improved. Nine knees required revision. Eleven patients required an additional arthroscopic procedure due to persisting pain secondary to intra-articular pathology, and four patients required manipulation under anaesthesia because of limited range of motion. The 7-year cumulative survival rate of the arthroplasty was 94.4%. A low incidence (21%) of a radiolucent line beneath the tibial component was observed at 5 years of follow-up. CONCLUSION: this study showed a high survival rate of the Oxford Phase 3 UKA. Patient satisfaction and functional performance were also very high. Major complication rate was low; in addition, the incidence of radiolucency under the tibial component, when compared to present literature, was low. When strict indication criteria are followed, excellent, durable, and in our opinion reliable, results can be expected for this procedure.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/rehabilitación , Humanos , Prótesis de la Rodilla , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Prospectivos , Diseño de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
PURPOSE: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control. METHODS: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA(1c) during the 1st trimester. RESULTS: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA(1c) values during the 1st trimester were associated with offspring fetal cardiovascular defects. CONCLUSION: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease.
Asunto(s)
Comparación Transcultural , Diabetes Mellitus Tipo 1/epidemiología , Cardiopatías Congénitas/epidemiología , Embarazo en Diabéticas/epidemiología , Estudios Transversales , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Enfermedades en Gemelos/diagnóstico , Enfermedades en Gemelos/epidemiología , Europa (Continente) , Femenino , Hemoglobina Glucada/metabolismo , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/diagnóstico , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , Recién Nacido , Insulina/uso terapéutico , Países Bajos , Embarazo , Embarazo en Diabéticas/sangre , Embarazo en Diabéticas/diagnóstico , Embarazo en Diabéticas/tratamiento farmacológico , Embarazo Múltiple , Valores de Referencia , Estudios Retrospectivos , Riesgo , Factores de Riesgo , Ultrasonografía Prenatal , Estados UnidosRESUMEN
Tibial tubercle osteotomy (TTO) is a well-known technique for improving exposure in difficult total knee arthroplasty (TKA). We have performed a review of the literature concerning this procedure with the purpose of evaluation using the clinical results and complication rates in primary and revision TKA using TTO. We conducted a search limited to the following databases: PubMed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase. These were searched from 1979 to May 2009 to identify studies relating to the primary and revisions of TKA using a tuberositas osteotomy. Eighteen studies met the inclusion criteria including 823 cases. In 762 cases, a medial TTO was performed. Most patients had an improved knee function after TKA. Proximal migration of the osteotomized site (n=18), TTO-related pain (n=17), and avulsion fractures of the tubercle (n=13) were the most reported complications of this technique. TTO is a relatively safe and reproducible procedure for the enhancement of surgical exposure in difficult primary or revision TKA. Serious complications related to TTO were reported in 8 to 9% of all cases. Future studies should compare different fixation methods in a prospective randomized controlled way.
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Artroplastia de Reemplazo de Rodilla/métodos , Osteotomía/métodos , Tibia/cirugía , Artroplastia de Reemplazo de Rodilla/instrumentación , Medicina Basada en la Evidencia , Humanos , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
Isolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury (Garrigues and Aldridge III in J Bone Joint Surg Am 89:1594-1597, 2007]. Reports of isolated DRUJ luxations, volair or dorsal, are often case reports and rarely a series of cases [Dameron Jr in Clin Orthop Relat Res 83:55-63, 1972]. We present a case of an acute traumatic dorsal DRUJ dislocation treated with cast immobilization with recurrence of the dislocation after a new trauma some months later. At follow-up, 17 months after the first dislocation and 9 months after the second, he experienced no pain and had no restrictions in work or sports-related activities.
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Malignant peripheral nerve sheath tumors are rare tumors, especially in the newborn period. Diagnosis is based on clinical findings, radiography, and fine needle biopsy or tissue sampling. Ideal management is controversial and extremely difficult. The survival rate is extremely low. We present a case of a newborn in which this tumor is diagnosed in the first few days of life as an ulcerating tumor imbedded in the entire forefoot with already metastatic spread to the lymph nodes and abdomen. Questions arose on the best treatment in postpartum life. Below the knee amputation was performed for nursing purposes, but eventually a no-intention-to treat policy was chosen by the multidisciplinary team and parents. Detection of soft tissue tumors in the prenatal period is difficult and not as easy as for other structural defects. Would prenatal detection have changed the course of life of this young infant? Will future opportunities for detection of soft tissue tumors occur? Diagnostic and therapeutic considerations are discussed alongside the present literature.
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Neoplasias Abdominales/secundario , Neoplasias de la Vaina del Nervio/secundario , Neoplasias de los Tejidos Blandos/patología , Neoplasias Abdominales/cirugía , Biopsia con Aguja Fina , Diagnóstico Diferencial , Resultado Fatal , Femenino , Pie , Humanos , Recién Nacido , Ganglios Linfáticos/patología , Metástasis Linfática , Neoplasias de la Vaina del Nervio/diagnóstico por imagen , Neoplasias de la Vaina del Nervio/cirugía , Pronóstico , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/cirugía , Tomografía Computarizada por Rayos XRESUMEN
In literature no reports appear on functional recovery of unicompartmental knee replacement using both subjective and objective methods. Functional aspects are especially of importance, since prosthetic replacement is considered more often in younger patients, who require an optimal knee function for activities such as sports. In a prospective study on 38 patients with a mean age of 62.2 years functional improvement was measured. Using Knee Society Score (KSS) as a clinician based score and the Dynaport Knee Test as a functional test measurements were performed at preoperative, 3 and 6 months, 1 and 2 years, after surgery. The Dynaport Knee Test is an accelerometer-based system that objectively measures functional aspects of gait during various tasks of daily life. It consists of four sub scores. The KSS assesses pain and function. Both scores range from 0 to 100. The mean KSS preoperative was 44.0 and improved significantly to 81.7 at 3 months (P<0.001) and to 87.4 (P=0.025) at 6 months. No significant differences were noted after 6 months. The mean preoperative Dynaport Knee Test score was 35.8 and at 3 months 43.6 (P<0.001), 48.6 at 6 months (P<0.001). No significant differences were noted after 6 months follow-up. Of the Dynaport sub scores, the low demanding tasks Lift and Move and Locomotion, cease to improve beyond 6 months. The high demanding task Transfers only improved up to 3 months. However, the other high demanding tasks Rise and Descend showed improvement beyond 1 year after surgery, since the improvement from 6 months to 2 years was significant (P=0.023). This study has found that functional recovery continues beyond 6 months and even up to 2 years. It seems only more challenging tests can discriminate on improvement beyond a point where questionnaires cease to improve. The use of objective measurement methods is advocated next to the clinician based scores and self reported questionnaires.
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Actividades Cotidianas , Artroplastia de Reemplazo de Rodilla/métodos , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Locomoción/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular/fisiología , Recuperación de la Función/fisiologíaRESUMEN
Background. Since the introduction minimally invasive techniques, interest in unicompartmental knee arthroplasty (UKA) has rapidly increased. This minimally invasive approach preserves the anatomy of the knee with less damage to extensor mechanisms, less morbidity, and quicker post-operative recovery. The purpose of our study was to evaluate this new treatment option for anteromedial osteoarthritis, both clinically and radiographically, and to identify any possible drawbacks. Material and methods. Between January 1999 and August 2003 88 consecutive Oxford Phase 3 UKAs were implanted by a single surgeon. All patients with a minimal follow-up (FU) period of 2 years were pre- and post- operatively clinically evaluated by the American Knee Society (AKS) Score and radiographically according to the Oxford Centre criteria, including fluoroscopy. Results. Twenty-eight patients with 30 prostheses with a minimal follow-up period 2 years (2.54 +/- 0.48 yrs) were included in this study. The AKS Knee, Function and Pain Score improved significantly at 2-year FU compared to the preoperative score, the preoperative varus deformity was corrected into alignment in all cases. Conclusions. Clinical and radiographical results of the Oxford Phase 3 prosthesis using a minimally invasive surgical technique confirmed previous good results achieved by the standard technique. Evaluation of our patients at a minimum FU of 2 years revealed a significant improvement of AKS scores. Postoperatively knee joint deformity was corrected into a physiological valgus alignment. Patient satisfaction is high, and the prosthesis provides good outcome for patients with anteromedial osteoarthritis when strict indication criteria are considered.
RESUMEN
OBJECTIVES: To review our 13-year experience with prenatally detected hypoplastic left heart syndrome (HLHS) of which management remains controversial. MATERIAL AND METHODS: Retrospective study of the management and outcome in all cases of HLHS diagnosed prenatally in a tertiary referral center for pediatric cardiology and cardiac surgery between January 1988 and July 2001. RESULTS: The diagnosis of HLHS was made in 32 fetuses. One mother had two pregnancies associated with HLHS. In 16 cases parents opted for termination of pregnancy and in five for compassionate care. Four fetuses died in utero, and seven patients received a palliative reconstructive Norwood procedure. In seven fetuses, associated anomalies were detected: three chromosomal and structural and four only structural. In six fetuses, other associated intracardiac anomalies were detected. Of seven infants operated, six had no associated anomalies and only one is alive at an age of 17 months. CONCLUSION: The low percentage of intention to treat among patients in our center (34%) is in accordance with the percentage found in another study from the UK (36.2%), but differs significantly from reported series across the Atlantic (67%). Prenatal diagnosis of the HLHS provides opportunities not only for getting patients in optimal preoperative condition when surgery is offered, but also for in-depth counseling of the parents on this severe malformation. A minority of parents faced with the difficult decision of possible termination of pregnancy, compassionate care or the Norwood strategy, choose surgical treatment which might be based on socioreligious differences and the interpretation of the long-term quality of life.