RESUMEN
PURPOSE: This study was performed to determine the usefulness of three-dimensional computed tomography (3D-CT) in measuring periacetabular osteolysis by comparing the real volume of osteolysis in revision surgery. MATERIALS AND METHODS: Twnety-three patients who had undergone revision surgery due to periacetabular osteolysis but not included septic osteolysis and implant loosening. The mean age of patients at the time of surgery was 55.2 years. And the mean time interval between the primary total hip arthroplasty and revision surgery was 13.3 years. We measured the polyethylene wear in plain radiographs using computer assisted vector wear analysis program, the volume of acetabular osteolytic lesions in high-resolution spiral CT scans using Rapidia 3D software version 2.8 algorithms before the revision surgery were performed. Intraoperative real osteolytic volume was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. RESULTS: Strong correlation was found between the volume of acetabular osteolytic lesions measured on 3D-CT and intraoperative real osteolytic volume which was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. CONCLUSION: 3D-CT is considered a useful method for assessing and measuring the volume of periacetabular osteolysis before revision surgery.
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Tendones/anomalías , Artroscopía , Descompresión Quirúrgica , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteofito/diagnóstico por imagen , Osteofito/patología , Radiografía , Esclerosis , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/patología , Tendones/patologíaRESUMEN
Venous thromboembolism (VTE) is a serious complication after major orthopedic surgery. This study examined the prevalence and risk factors of VTE in patients undergoing arthroplasty without thromboprophylaxis. A total of 1608 patients who underwent elective knee or hip arthroplasty between 1996 and 2009 were evaluated. The incidence of VTE was 1.99% (n = 32). Of them, 0.24% (n = 4) were diagnosed with a pulmonary embolism. The risk factors associated with VTE were female sex, revision surgery, bilateral simultaneous procedure, CVA (cerebrovascular accident; thromboembolic stroke) history, and preoperative platelet count (all P > .05). There was an annual increase in the prevalence of VTE from 1996 to 2009 (P = .002). According to these results, thromboprophylaxis is strongly recommended in high-risk groups of Korean arthroplasty patients.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Tromboembolia Venosa/etiología , Anciano , Femenino , Humanos , Masculino , Prevalencia , Embolia Pulmonar/etiología , Reoperación , República de Corea/epidemiología , Factores de Riesgo , Ultrasonografía , Tromboembolia Venosa/diagnóstico por imagen , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/etiologíaRESUMEN
Autologous chondrocyte implantation (ACI) is widely used to treat symptomatic articular cartilage injury of the knee. Fibrin ACI is a new tissue-engineering technique for the treatment of full-thickness articular cartilage defects, in which autologous chondrocytes are inserted into a three-dimensional scaffold provided by fibrin gel. The objective of this study is to document and compare mean changes in overall clinical scores at both baseline and follow-up. Fibrin ACI was used to treat deep cartilage defects of the femoral condyle in 30 patients. There were 24 men and 6 women with a median age of 35 years (range 15-55) and with a mean defect size of 5.8 cm(2) (range 2.3-12). Clinical and functional knee evaluations were performed using different scoring systems, MRI was performed 24 months postoperatively, and arthroscopy was performed 12 months postoperatively. All patients achieved clinical and functional status improvements following surgery (P < 0.01). The mean scores of the Henderson classification (MRI evaluation) significantly improved from 14.4 to 7 (P = 0.001), and no graft-associated complications were noted. Arthroscopic assessments performed 12 months postoperatively produced nearly normal (grade II) International Cartilage Repair Society scores in 8 of the 10 study patients. Fibrin ACI offers the advantages of technical simplicity, minimal invasiveness, a short surgery time, and easier access to difficult sites than classical ACI. Based on the findings of this clinical pilot study, we conclude that fibrin ACI offers a reliable means of treating articular cartilage defects of the knee.
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Cartílago Articular/lesiones , Cartílago Articular/cirugía , Condrocitos/trasplante , Fibrina/fisiología , Traumatismos de la Rodilla , Adolescente , Adulto , Colágeno/metabolismo , Femenino , Estudios de Seguimiento , Glicosaminoglicanos/metabolismo , Humanos , Traumatismos de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ingeniería de Tejidos/métodos , Trasplante Autólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7 degrees before surgery to 6.8 degrees after surgery in the L5 group, and from 22.8 degrees to 7.7 degrees in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.
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Artrodesis/métodos , Desplazamiento del Disco Intervertebral/complicaciones , Vértebras Lumbares/cirugía , Sacro/cirugía , Escoliosis/cirugía , Fusión Vertebral/métodos , Anciano , Artrodesis/efectos adversos , Artrodesis/instrumentación , Tornillos Óseos/efectos adversos , Tornillos Óseos/normas , Tornillos Óseos/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Femenino , Humanos , Fijadores Internos/normas , Fijadores Internos/estadística & datos numéricos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/patología , Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/fisiopatología , Lordosis/patología , Lordosis/fisiopatología , Lordosis/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Hemorragia Posoperatoria/fisiopatología , Cuidados Preoperatorios/métodos , Radiografía , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Factores de Riesgo , Sacro/anatomía & histología , Sacro/diagnóstico por imagen , Escoliosis/etiología , Escoliosis/fisiopatología , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Resultado del TratamientoRESUMEN
PURPOSE: This study examined the rate of degeneration of acetabular cartilage by the bipolar head according to time, and also which clinical factors are related to the degeneration of acetabular cartilage. MATERIALS AND METHODS: Among 192 patients (226 hip joints) who received bipolar hemiarthroplasty from August 1996 to August 2002, 61 patients (65 hip joints) were enrolled in this study, who were followed up for more than 2 years and showed no signs of dislocation, infection, or functional problems. A modified form of a computer assisted vector wear analysis program was used to measure the rate of degeneration of the acetabular cartilage. The factors that appeared to affect the rate of acetabular degeneration in the two groups was evaluated. RESULTS: The average linear degenerative change in the acetabular cartilage and the volumetric degenerative change were 0.23 +/- 0.107mm/year and 114 +/- 47.2mm3/year, respectively. The result showed significant differences in activity and HHS between the 2 groups. The HHS showed a reverse relationship with the linear degeneration and volumetric degeneration, and the activity showed a correlation with the linear and volumetric degeneration. CONCLUSION: The acetabular cartilage degenerates faster as the patient' activity increases, and slower with a higher HHS. When surgeons perform hip joint arthroplasty, it is strongly recommended that the life expectancy and the level of activity should be considered when deciding between a hemiarthroplasty and total hip arthroplasty.