RESUMEN
Same-stage tibial osteotomy may deserve consideration in candidates to total knee arthroplasty (TKA) who have severe bone deformities, particularly at extra-articular sites. This strategy obviates the need for either a major and technically difficult ligament release procedure, which may compromise ligament balancing, or the use of a semi-constrained prosthesis. This technical note describes a one-stage, computer-assisted technique consisting in TKA, followed by corrective tibial osteotomy to obtain an overall mechanical axis close to 180° without extensive ligament balancing. This technique provided satisfactory outcomes in 8 patients followed-up for at least 3years, with no specific complications or ligament instability and with a hip-knee-ankle angle close to 180°. After planning, intra-operative computer assistance ensures accurate determination of both implant position and the degree of correction achieved by the osteotomy.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteotomía/métodos , Cirugía Asistida por Computador , Tibia/cirugía , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/fisiología , Huesos , Femenino , Estudios de Seguimiento , Genu Valgum/cirugía , Genu Varum/cirugía , Articulación de la Cadera/fisiología , Humanos , Articulación de la Rodilla/fisiología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: The goal of mobile-bearing total knee arthroplasties (TKA) with an anatomical trochlea is to reduce polyethylene wear, the risk of loosening, and patellofemoral complications. Rotating mobile-bearing SCORE(®) TKA was designed according to these principles with standard instrumentation for component placement and a specific computer navigation system, Amplivision(®). HYPOTHESIS: We hypothesized that the results of SCORE(®) TKA would be satisfactory and better using computer navigation with or without patellar resurfacing and that there would be no specific patellofemoral complications associated with this trochlear design. MATERIALS AND METHODS: Four hundred and forty-seven SCORE(®) TKA were performed. Outcome assessment was based on the IKS score, and component survival calculated by Kaplan-Meier analysis. RESULTS: Mean follow-up was 6.6 years (maximum 10.6 years). Six percent of patients were lost to follow-up. Ninety-eight percent of the patients were satisfied or very satisfied. The IKS knee score was 89 points and the function score was 86. The mechanical axis was 180° (174-186), and it was significantly improved if the initial deformity was severe and TKA was computer navigated. There were nine revisions (one for fracture, two for pain, two for stiffness, four for infection). DISCUSSION: This study confirmed our hypothesis: the results of SCORE(®) TKA were very satisfying after at least 5 years of follow-up because there was no mechanical loosening, no bearing dislocation and no patellofemoral complications with or without patellar resurfacing. Results were identical whether patellar resurfacing was performed or not. Although clinical results were not better for computer- navigated TKA, radiological results were. At 98 months of follow-up, component survival in relation to the risk of aseptic loosening or patellofemoral complications was 100%. LEVEL OF EVIDENCE: Level IV continuous retrospective study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Diseño de Prótesis , Rango del Movimiento Articular/fisiología , Cirugía Asistida por Computador/métodos , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente/estadística & datos numéricos , Falla de Prótesis , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Total hip arthroplasty is a frequent procedure with functional outcome that generally is excellent and lasting. Routine imaging follow-up is necessary to detect complications such as loosening and wearing out. Additional imaging with scintigraphy, CT, ultrasound or MRI may be necessary.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Articulación de la Cadera/cirugía , Humanos , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
PURPOSE OF THE STUDY: Revision total hip arthroplasty (THA) after hip arthrodesis is an uncommon and challenging operation. The task would appear to be even more difficult if the arthrodesis was performed because of septic arthritis due to the theoretical risk of recurrent infection. We report our fifteen-year experience. MATERIAL AND METHODS: This retrospective study concerned 17 procedures performed in 17 patients (11 women, 6 men) between 1988 and 2003 on 5 right and 12 left hips. All of the patients had arthrodesis for sepsis: eight subsequent to tuberculosis and nine subsequent to septic arthritis (Staphylococcus aureus). We examined the impact of the initial arthrodesis (surgical technique, position, leg length) on neighboring joints and indications for de-fusion. Mean age was 53 years (range 32-74) and on average, the patients had a fixed hip for 36 years (range 7-59). Mean follow-up was six years (range 11 months to 15 years). Revision surgery was performed via a posterolateral approach for 12 hips (nine trochanterotomies) and via an anterolateral approach for five hips for implantation of nine cemented implants, six press fit implants, and two hybrid implants (cemented cup and press fit stem). Clinical assessment at last follow-up noted pain, walking capacity and joint motion. Leg length discrepancy was measured and complications were noted. RESULTS: The position of the original arthrodesis was considered satisfactory (flexion 20 degrees , adduction 0-10 degrees , external rotation 0-20 degrees ) for eight hips; leg length discrepancy was 4 cm (2-8 cm). Neighboring joints involved concerned the lumbar spine in 15 patients, the ipsilateral knee in ten patients, the contralateral knee in eight and the contralateral hip in six. The decision to remove the arthrodesis was based on functional needs related to lumbar pain (n=6), the homolateral knee (n=10, limping and leg length discrepancy), or an operation on the ipsilateral knee. After surgery, 14 hips (83%) were free of pain with improvement of the lumbar pain and pain of the homolateral knee. Six patients walked without support but 16 still had a limp. Flexion was 78 degrees . Leg length discrepancy was 2.5 cm on average and seven patients had balanced limbs. The postoperative period was uneventful for 14 of 17 patients (one paresia of the common fibular nerve, one femoral phlebitis, one early infection). Six late complications were noted: nonunion of the greater trochanter (n=2), recurrent ankylosis (n=1) and loosening (n=3). DISCUSSION AND CONCLUSION: An earlier history of infection does not appear to be a contraindication for implantation of a total hip arthroplasty after hip arthrodesis. Despite the long recovery period and the modest gain in joint motion, 80% of patients were satisfied after having had a blocked hip for 36 years on average.
Asunto(s)
Artritis Infecciosa/cirugía , Artrodesis/métodos , Artroplastia de Reemplazo de Cadera/métodos , Articulación de la Cadera/cirugía , Adulto , Anciano , Artralgia/etiología , Artrodesis/efectos adversos , Cementación/métodos , Femenino , Fémur/cirugía , Estudios de Seguimiento , Marcha/fisiología , Humanos , Prótesis Articulares , Diferencia de Longitud de las Piernas/etiología , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Rango del Movimiento Articular/fisiología , Reoperación , Estudios Retrospectivos , Infecciones Estafilocócicas/cirugía , Tuberculosis Osteoarticular/cirugía , Caminata/fisiologíaRESUMEN
Of 376 cemented posterior stabilized HLS1 TKRs inserted in 329 patients (mean age 70) between 1984 and 1988, information was available on 306 (81.4%) at the third follow-up in 1998: 118 patients deceased; 163 followed up clinically (Knee Society score) and radiographically; 25 revised (15 infections; 10 mechanical failures). At a mean follow-up of 11.5 years, the mean pain score was 43/50, and the mean ROM score 21/25 (both unchanged since 1989). The function score had declined linearly, from 70/100 in 1989 to 60/100 in 1998. Forty percent had tibial radiolucencies correlating with the extent of preoperative bone wear. Polyethylene wear (seen in 35% of knees) was always < 3 mm. The implant survival rate (infections included) was 93.7% (+/- 1.4%) after 10 years. All the mechanical failures were in advanced-OA patients with ACL-deficient knees and major bony deficiencies.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Artralgia/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: We report our experience with percutaneous sacroiliac screwing for unstable pelvic ring fracture. MATERIAL AND METHODS: Twenty unstable pelvic ring fractures with sacroiliac disjunction (9 cases), trans-sacral fracture (9 cases), or bilateral posterior fractures (5 cases) were managed with percutaneous sacroiliac fixation using 1 or 2 screws. There was also pubic disjunction in 7 cases, managed by osteosynthesis in 5 cases. No fixation of fractures of one or both of the obturator rings, present in 13 cases, was attempted. The posterior screwing was performed under fluoroscopic guidance in 15 cases and computed tomographic guidance in 5. RESULTS: There were no infectious or neurological complications. Radiographically, anatomic reduction of the posterior fracture was achieved in 10 cases. A vertical ascension persisted in 4 patients and a rotation in 6. Radiographic results were correlated with delay to surgery: correction of the vertical displacement was achieved in 80% of the patients operated before five days and in 55% of the others. Two patients experienced a secondary displacement. There was no cases of nonunion of either the anterior or posterior fracture. Follow-up was available for 14 patients (2 patients died and follow-up was too short for 4). The mean Majeed score was 92/100 and none of the patients experienced anterior pain. Three patients had moderate pain in the sacroiliac area. DISCUSSION: The ventral position appears to be best adapted for percutaneous sacroiliac screwing but can be contraindicated by concomitant lesions. We prefer fluoroscopic guidance for these emergency procedures. Two views, ascending and descending, appear sufficient. The better stability provided by two screws can be achieved under computed tomographic guidance without risk of neurovascular damage. CONCLUSION: Percutaneous sacroiliac screwing is a good management strategy for unstable pelvic ring fractures with little risk of morbidity.