RESUMEN
INTRODUCTION: the pandemic of COVID-19 has led to clinical complications such as avascular necrosis of the femoral head (AVNFH) associated with the use of corticosteroids. The aim of the study is to report the functional and radiographic results of 13 patients with post-COVID-19 ANFH after decompression using Forage and bone marrow aspirate concentrate (BMAC). MATERIAL AND METHODS: single-center, prospective, uncontrolled clinical study. From April 2020 to September 2021, 13 patients (21 hips) with post-COVID-19 ANFH were treated. All received corticosteroids during infection (average daily dose: 480 mg). Clinical, radiographic and magnetic resonance imaging evaluations were performed; the Ficat classification was applied for the classification of AVNFH. The surgical technique used was decompression with Forage and ACMO. RESULTS: the mean age was 47 years, with a follow-up of 30.4 months. Symptoms appeared with a mean of 4.2 months after COVID-19 infection. Harris score improved from 41.2 ± 5.2 to 86.6 ± 3.4. Radiographic evaluation showed that 14.3% of the sample experienced femoral head collapse and underwent total hip arthroplasty. CONCLUSIONS: post-COVID-19 ANFH is a clinical entity with rapid progression and different degrees of severity. Decompression with Forage and ACMO seems a promising initial treatment, however, the variable response and the probability of collapse emphasize the importance of long-term follow-up and identification of patients who may require additional interventions.
INTRODUCCIÓN: la pandemia de COVID-19 ha dado lugar a complicaciones clínicas como la necrosis avascular de la cabeza femoral (NAVCF) asociada con el uso de corticoesteroides. El objetivo del estudio es reportar los resultados funcionales y radiográficos de 13 pacientes con NAVCF post-COVID-19, después de la descompresión utilizando Forage y aspirado de células de medula ósea (ACMO). MATERIAL Y MÉTODOS: estudio clínico unicéntrico, prospectivo, no controlado. Desde Abril de 2020 hasta Septiembre de 2021, se trataron 13 pacientes (21 caderas) con NAVCF post-COVID-19. Todos recibieron corticoesteroides durante la infección (dosis promedio diaria: 480 mg). Se realizaron evaluaciones clínicas, radiográficas y por resonancia magnética nuclear; se aplicó la clasificación de Ficat para la clasificación de NAVCF. La técnica quirúrgica empleada fue descompresión con Forage y ACMO. RESULTADOS: la edad promedio fue 47 años, con un seguimiento de 30.4 meses. Los síntomas aparecieron con una media de 4.2 meses después de la infección por COVID-19. La escala de Harris mejoró de 41.2 ± 5.2 a 86.6 ± 3.4. La evaluación radiográfica demostró que 14.3% de la muestra experimentó colapso de la cabeza femoral por lo que se les realizó artroplastía total de cadera. CONCLUSIONES: la NAVCF post-COVID-19 es una entidad clínica con rápida progresión y diferentes grados de severidad. La descompresión con Forage y ACMO parece un tratamiento inicial prometedor; sin embargo, la respuesta variable y la probabilidad de colapso, enfatizan la importancia de seguimiento a largo plazo e identificación de los pacientes que puedan requerir intervenciones adicionales.
Asunto(s)
COVID-19 , Descompresión Quirúrgica , Necrosis de la Cabeza Femoral , Humanos , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/etiología , COVID-19/complicaciones , Descompresión Quirúrgica/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Resultado del Tratamiento , Trasplante de Médula Ósea/métodos , Corticoesteroides/uso terapéutico , Corticoesteroides/administración & dosificación , Imagen por Resonancia Magnética , Estudios de SeguimientoRESUMEN
Long COVID is a term used to describe the long-terms effects of COVID-19 infection that continue for weeks or months after the patient has recovered from COVID-19. Long COVID is defined by the persistence of symptoms beyond 12 weeks from the onset of the disease. Corticosteroids are part of the treatment in this period with good results in controlling the disease; however, it is a predisposing factor for the development of avascular necrosis. We present a clinic case of a young man of 39 years old with diagnosis of avascular necrosis in his left hip, before the administration of corticosteroids for the treatment of COVID-19. There is a lack of consensus about the dosage and duration of steroids required to develop avascular necrosis. Some authors have reported that cumulative dose of 2,000 mg prednisone (or its equivalent) was required for avascular necrosis development. For patients with advanced avascular necrosis stages total hip arthroplasty is an attractive option with excellent outcomes in terms of pain relief and survivorship.
El COVID de larga duración es un término que describe la enfermedad en pacientes que se recuperaron de una infección por COVID-19 y reportan síntomas por más de 12 semanas. Los corticosteroides forman parte del tratamiento en este período con buenos resultados en el control de la enfermedad; sin embargo, el uso de este grupo de medicamentos se ha descrito como un factor de riesgo para el desarrollo de necrosis avascular. Se describe el caso clínico de un paciente masculino de 39 años con diagnóstico de necrosis avascular de la cadera izquierda posterior a la administración de corticosteroides para el tratamiento de COVID-19. La dosis de esteroides capaz de provocar necrosis avascular no está clara o bien descrita; sin embargo, existen reportes en la literatura donde se habla de dosis de 2,000 mg de prednisona (o equivalentes) para su desarrollo. El tratamiento de la necrosis avascular tiene como objetivo el alivio del dolor, retardar la progresión del cuadro, prevenir el colapso en etapas tempranas y restaurar la función articular. La artroplastía o recambio total de cadera parece ser una excelente opción de tratamiento quirúrgico para aquellos pacientes en etapas avanzadas.
Asunto(s)
COVID-19 , Necrosis de la Cabeza Femoral , Humanos , Masculino , COVID-19/complicaciones , Adulto , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/cirugía , Factores de Tiempo , Artroplastia de Reemplazo de Cadera , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificaciónRESUMEN
INTRODUCTION: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. MATERIAL AND METHODS: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. RESULTS: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). CONCLUSIONS: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.
INTRODUCCIÓN: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. MATERIAL Y MÉTODOS: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. RESULTADOS: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). CONCLUSIÓN: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Necrosis de la Cabeza Femoral , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/cirugía , Humanos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Resumen: Introducción: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. Material y métodos: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg ≤ IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. Resultados: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). Conclusión: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.
Abstract: Introduction: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. Material and methods: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg ≤ IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. Results: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). Conclusions: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.
Asunto(s)
Humanos , Artroplastia de Reemplazo de Cadera , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/epidemiología , Estudios Prospectivos , Resultado del Tratamiento , Cabeza Femoral/cirugíaRESUMEN
BACKGROUND: Cell-therapy has been promoted among the therapeutic arsenal that can aid in bone formation and remodeling, in early stages of osteonecrosis of the femoral head (ONFH). The purpose of this systematic review was to assess the evidence supporting the (1) clinical efficacy; (2) structural modifying effect, as evaluated radiographically; (3) revision rates; and (4) safety of cell-therapy for the treatment of ONFH. METHODS: A systematic review was performed including studies with a level-of-evidence of III or higher. A total of 1483 articles were screened. Eleven studies met the criteria for inclusion in this review (level-of-evidence: 6 level-I, 1 level-II, and 4 level-III), including 683 cases of ONFH. RESULTS: All 10 studies that reported patient-reported outcomes showed improved outcomes in the cell-therapy groups compared with the control group. Overall, 24.5% (93/380 hips) that received cell-therapy showed radiographic progression compared with 40% (98/245 hips) in the control group. Nine of 10 studies that reported failure rates showed a lower total hip arthroplasty conversion rate in the cell-therapy group 16% (62/380 hips) compared with the control group 21% (52/252 hips). There was a low complication rate (<3%) with no major adverse effects. CONCLUSION: Cell-therapies for the treatment of ONFH have been reported to be safe and suggest improved clinical outcomes with lower disease progression rate. However, there was substantial heterogeneity in the included studies, and in the cell-based therapies used. Specific clinical indications and cell-therapy standardization are required because studies varied widely with respect to cell sourcing, cell characterization, adjuvant therapies, and assessment of outcomes.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Necrosis de la Cabeza Femoral/cirugía , Cabeza Femoral/cirugía , Cadera/cirugía , Adulto , Terapia Combinada , Progresión de la Enfermedad , Femenino , Cabeza Femoral/patología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Resultado del TratamientoRESUMEN
Osteonecrosis of the femoral head leads to degeneration of the head and finally to osteoarthritis of the hip. Decompression is the most widely used treatment, but its effectiveness is limited. It has been proposed instillation of stem cells in addition to decompression, would lead to better results. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including two randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded instillation of bone marrow stem cells at the time of core decompression probably slows progression to osteoarthritis of the hip in patients with osteonecrosis of the femoral head and might reduce the need of subsequent surgeries. It is unclear whether it has any effect on the functionality because the certainty of the evidence is very low.
La osteonecrosis de cabeza femoral lleva a degeneración de la cabeza y finalmente al desarrollo de artrosis de cadera. La descompresión constituye el tratamiento más utilizado, sin embargo su eficacia es limitada. Se ha planteado que la instilación de células madre en conjunto con la descompresión tendría mejores resultados. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen dos estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que instilar células madre de médula ósea al momento de la descompresión ósea en la osteonecrosis de cabeza femoral probablemente disminuye la progresión a artrosis de cadera y podría disminuir la necesidad de cirugías posteriores. No está claro si tiene algún efecto sobre la funcionalidad porque la certeza de la evidencia es muy baja.
La osteonecrosis de cabeza femoral lleva a degeneración de la cabeza y finalmente al desarrollo de artrosis de cadera. La descompresión constituye el tratamiento más utilizado, sin embargo su eficacia es limitada. Se ha planteado que la instilación de células madre en conjunto con la descompresión tendría mejores resultados. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen dos estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que instilar células madre de médula ósea al momento de la descompresión ósea en la osteonecrosis de cabeza femoral probablemente disminuye la progresión a artrosis de cadera y podría disminuir la necesidad de cirugías posteriores. No está claro si tiene algún efecto sobre la funcionalidad porque la certeza de la evidencia es muy baja.
Asunto(s)
Trasplante de Médula Ósea/métodos , Descompresión Quirúrgica/métodos , Necrosis de la Cabeza Femoral/cirugía , Células de la Médula Ósea/citología , Bases de Datos Factuales , Progresión de la Enfermedad , Necrosis de la Cabeza Femoral/patología , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.
Asunto(s)
Trasplante de Médula Ósea/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteonecrosis/cirugía , Estudios de Seguimiento , Humanos , Resultado del TratamientoRESUMEN
The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.
Asunto(s)
Humanos , Trasplante de Médula Ósea/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteonecrosis/cirugía , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of the present study was to evaluate health-related quality of life in pediatric patients with avascular necrosis of the femoral head. MATERIAL AND METHODS: A comparative study was conducted involving 32 children and adolescents in "ONFH Group" (subjects with a diagnosis of ONFH) and 44 in "Comparison Group" (asymptomatic children), both aged between 8 and 18. Clinical and sociodemographic data were obtained along with PedsQL 4.0 questionnaires to evaluate the quality of life in the age-ranges studied. RESULTS: The two groups were similar as regards sociodemographic characteristics. Comparison of the quality of life total scores demonstrated significant differences between the ONFH group and the comparison group (58.86±16.54 versus 82.08±9.51), and this also occurred in all the domains analyzed. The predictors that showed correlation with the quality of life were: presence of necrosis, age, time of diagnosis, radiographic classification, Charnley score, educational level, previous surgeries, and previous infections. CONCLUSION: Our data confirm the hypothesis that pediatric patients with ONFH demonstrate a lower quality of life than healthy children in all the domains evaluated, especially with regard to the physical aspect.
Asunto(s)
Necrosis de la Cabeza Femoral/psicología , Necrosis de la Cabeza Femoral/cirugía , Cabeza Femoral/cirugía , Pacientes/psicología , Calidad de Vida/psicología , Adolescente , Factores de Edad , Brasil , Niño , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Adult aseptic necrosis of the femoral head progresses from its reversible phase, stages I-II-III (Ficat-ARCO), to stages IV-V coxarthrosis, and this represents a health problem. An observational, descriptive, prospective, case-series type of study was conducted to prove the hypothesis that the boring decompression of the femoral neck-head cancellous layer, together with the local implantation of multipotent adult autologous stem cells processed according to Ficoll at approximate amounts of 16.1 x 10(6) cells/ml, is the treatment of choice for stages I-II-III of aseptic necrosis of the femoral head. These cells create the necessary tissue conditions to preserve the structure of the femoral head thus avoiding or delaying its degeneration and the resulting prosthetic arthroplasty. A total of 16 patients with a diagnosis of stages I-II-III aseptic necrosis of the hip, ages 40-70, all of whom were at the reversible stage and accepted the above mentioned procedure, were included. The evaluation was conducted in June 2011 applying Harris' pain-function scale. Its score was used to determine the mean, the standard deviation and the median. Pain relief and functional recovery without surgical or immune complications were proven. According to Harris' score, 3 stage-III patients were under the median. One stage-III patient required prosthetic arthroplasty, so 93.7% of the patients retained their femoral head more than 2 years after the surgery. We conclude that the proposed procedure is the procedure of choice for stages I-II and it makes us be more selective in the case of stage III necrosis.
Asunto(s)
Necrosis de la Cabeza Femoral/cirugía , Trasplante de Células Madre , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: sacral insufficiency fractures are a cause of debilitating pain in the elderly. These fractures were first described as a clinical entity in 1982. The bone in these patients is structurally weakened and often associated with diseases such as osteoporosis, cancer and immunological processes. This translates into back and pelvic pain unrelated to trauma. These fractures are usually caused by fatigue in most cases. Bone scans and MRI are the imaging studies with the most sensitivity for detecting sacral insufficiency. CLINICAL CASES: two patients with sacral insufficiency fractures who were studied by MRI and bone scan, in whom the diagnosis of sacral insufficiency was made, were treated by sacroplasty. CONCLUSIONS: sacral insufficiency is an underdiagnosed disease, caused by wide range of diseases, mainly osteoporosis. The studies of choice for diagnosis are MRI and bone scans. Techniques, such as percutaneous sacroplasty, produce significant improvements in pain scores and seem a suitable alternative for managing this disease.
Asunto(s)
Fracturas por Estrés/complicaciones , Dolor de la Región Lumbar/etiología , Sacro/lesiones , Fracturas de la Columna Vertebral/complicaciones , Accidentes por Caídas , Anciano , Enfermedades Óseas Metabólicas/complicaciones , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Femenino , Necrosis de la Cabeza Femoral/complicaciones , Necrosis de la Cabeza Femoral/diagnóstico , Necrosis de la Cabeza Femoral/cirugía , Fracturas Espontáneas/complicaciones , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/diagnóstico por imagen , Fracturas por Estrés/diagnóstico , Fracturas por Estrés/diagnóstico por imagen , Fracturas por Estrés/cirugía , Humanos , Imagenología Tridimensional , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Sacro/diagnóstico por imagen , Sacro/cirugía , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico , Espondilolistesis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , VertebroplastiaRESUMEN
PURPOSE: Evaluate the bone tissue recovery following transplantation of ovine mesenchymal stem cells (MSC) from bone marrow and human immature dental-pulp stem cells (hIDPSC) in ovine model of induced osteonecrosis of femoral head (ONFH). METHODS: Eight sheep were divided in three experimental groups. First group was composed by four animals with ONFH induced by ethanol through central decompression (CD), for control group without any treatment. The second and third group were compose by two animals, six weeks after ONFH induction received transplantation of heterologous ovine MSC (CD + oMSC), and hIDPSC (CD + hIDPSC), respectively. In both experiments the cells were transplanted without application of any type of immunosupression protocol. RESULTS: Our data indicate that both cell types used in experiments were able to proliferate within injured site providing bone tissue recovery. The histological results obtained from CD+hIDPSC suggested that the bone regeneration in such animals was better than that observed in CD animals. CONCLUSION: Mesenchymal stem cell transplant in induced ovine osteonecrosis of femoral head by central decompression technique is safe, and apparently favors bone regeneration of damaged tissues.
OBJETIVO: Verificar os efeitos das células-tronco mesenquimais da medula óssea de ovinos e da polpa dentária imatura humana em ovinos com osteonecrose induzida, da cabeça do fêmur. MÉTODOS: Oito ovelhas foram distribuídas em três grupos experimentais. O primeiro grupo foi composto por quatro animais com osteonecrose da cabeça do fêmur induzida por etanol através da descompressão central, que não receberam nenhum tratamento. O segundo e o terceiro grupo, cada um composto por dois animais, receberam transplante heterólogo de células tronco mesenquimais de ovinos e polpa dentária imatura humana seis semanas após a indução da osteonecrose da cabeça do fêmur, respectivamente. Em ambos os grupos experimentais as células foram transplantadas sem o uso de drogas imunossupressoras. RESULTADOS: Os achados demonstram que as células-tronco mesenquimais injetadas na cabeça do fêmur se encontravam viáveis após o transplante no novo sítio e proliferaram em pouco tempo. Os dados histológicos sugerem que a regeneração óssea nos animais transplantados com polpa dentária imatura humana foi mais rápida do que nos animais submetidos somente a descompressão central. CONCLUSÃO: O transplante de células tronco mesenquimais na osteonecrose da cabeça do fêmur induzida em ovinos através da técnica de descompressão central é um procedimento seguro, e aparentemente favorece a regeneração óssea de tecidos lesados.
Asunto(s)
Animales , Humanos , Pulpa Dental/trasplante , Necrosis de la Cabeza Femoral/cirugía , Trasplante de Células Madre Mesenquimatosas , Materiales Biocompatibles/efectos adversos , Modelos Animales de Enfermedad , Trasplante de Células Madre Mesenquimatosas/efectos adversos , Distribución Aleatoria , Ovinos , Trasplante HeterólogoRESUMEN
PURPOSE: Evaluate the bone tissue recovery following transplantation of ovine mesenchymal stem cells (MSC) from bone marrow and human immature dental-pulp stem cells (hIDPSC) in ovine model of induced osteonecrosis of femoral head (ONFH). METHODS: Eight sheep were divided in three experimental groups. First group was composed by four animals with ONFH induced by ethanol through central decompression (CD), for control group without any treatment. The second and third group were compose by two animals, six weeks after ONFH induction received transplantation of heterologous ovine MSC (CD + oMSC), and hIDPSC (CD + hIDPSC), respectively. In both experiments the cells were transplanted without application of any type of immunosupression protocol. RESULTS: Our data indicate that both cell types used in experiments were able to proliferate within injured site providing bone tissue recovery. The histological results obtained from CD+hIDPSC suggested that the bone regeneration in such animals was better than that observed in CD animals. CONCLUSION: Mesenchymal stem cell transplant in induced ovine osteonecrosis of femoral head by central decompression technique is safe, and apparently favors bone regeneration of damaged tissues.
Asunto(s)
Pulpa Dental/trasplante , Necrosis de la Cabeza Femoral/cirugía , Trasplante de Células Madre Mesenquimatosas , Animales , Materiales Biocompatibles/efectos adversos , Modelos Animales de Enfermedad , Humanos , Trasplante de Células Madre Mesenquimatosas/efectos adversos , Distribución Aleatoria , Ovinos , Trasplante HeterólogoRESUMEN
UNLABELLED: Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. LEVEL OF EVIDENCE: Level IV retrospective historical study.
Asunto(s)
Cabeza Femoral/lesiones , Fijación Interna de Fracturas/métodos , Luxación de la Cadera/cirugía , Fracturas de Cadera/cirugía , Adulto , Artroplastia de Reemplazo de Cadera , Nalgas/cirugía , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/cirugía , Estudios de Seguimiento , Curación de Fractura/fisiología , Luxación de la Cadera/diagnóstico por imagen , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/etiología , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Radiografía , ReoperaciónRESUMEN
INTRODUCTION: Osteonecrosis of the femoral head (ONFH) is a frequent complication of sickle-cell disease. Numerous studies have demonstrated increased intraosseous pressure (IOP) in idiopathic necrosis and necrosis secondary to corticotherapy or alcohol poisoning. Several reports have testified to the clinical interest of decompression by drilling which, when performed in the early course of the pathology, can arrest or slow evolution. To the best of our knowledge, no studies have reported IOP increase in sickle-cell ONFH. The present study sought to show that intraosseous hyperpressure plays a role in the physiopathology of sickle-cell, like idiopathic, ONFH. MATERIALS AND METHODS: Sixteen intraosseous pressure (IOP) measurements were taken: eight in adult sickle-cell disease patients, four in sickle-cell trait carrying ONFH patients (AS) and four in non-sickle-cell ONFH patients (AA). Arterial blood-pressure equipment with bone-puncture needle was used to measure IOP in the great trochanter body. Three IOP measurements were made after zero calibration: before drilling (direct pressure: IOP-1), after hyperpressure test but before drilling (IOP-2), and after drilling (IOP-3). RESULTS: The present, admittedly short, series displayed elevated predrilling IOP-1 and IOP-2, reduced after drilling (IOP-3). Abnormal IOP fell after drilling performed for evolutive symptomatic ONFH. Significant differences in IOP-1 and IOP-2 were found, these being higher in the "sickle-cell disease" and "sickle-cell trait carriers" groups (p<0.05). Only in the sickle-cell groups was there a significant correlation between pain score and hyperpressure level, with significantly reduced pain after drilling. DISCUSSION: The elevated IOP levels found in symptomatic sickle-cell hips were comparable to those reported in the literature. Ischemia due to femoral head sinusoid occlusion by falciform globules with secondary intraosseous hyperpressure is the cause of the pain and of the onset and evolution of ONFH. The drilling tunnel acts as a safety valve, achieving real decompression of the segment involved and immediate postoperative reduction in or disappearance of pain. CONCLUSION: Measuring pressure is of diagnostic interest in sickle-cell disease patients with symptomatic hips. Manometry can be performed independently of surgery, under local anesthesia, and provides early confirmation of ONFH in geographic regions in which MRI is not readily available. It can be carried out very straightforwardly, without pressure sensor, using a simple water column (physiological saline) and three-way tap. Peroperative comparison of IOP-1 and IOP-3 is a means of assessing the effectiveness of decompression drilling.
Asunto(s)
Anemia de Células Falciformes/diagnóstico , Necrosis de la Cabeza Femoral/diagnóstico , Necrosis de la Cabeza Femoral/cirugía , Adolescente , Adulto , Factores de Edad , Anemia de Células Falciformes/complicaciones , Estudios de Casos y Controles , Descompresión Quirúrgica/métodos , Progresión de la Enfermedad , Femenino , Necrosis de la Cabeza Femoral/etiología , Estudios de Seguimiento , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Manometría/métodos , Persona de Mediana Edad , Presión/efectos adversos , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Rasgo Drepanocítico/complicaciones , Rasgo Drepanocítico/diagnóstico , Resultado del Tratamiento , Adulto JovenRESUMEN
Efficacy of osteointegration of tantalum porous systems has been demonstrated through animal experimentation. However, there is a lack of studies that evaluate osteointegration of implants retrieved after a period of implantation in humans. For this study, eight rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty three months. Observation during this study has confirmed effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. Bone in growth however, proved to be of a slower and less intense degree than that resulting within animal species during first months after implantation. Nevertheless, the results obtained in the quantitative evaluation of this process proved to be similar to those results achieved by other authors in previous experimental studies.
Asunto(s)
Necrosis de la Cabeza Femoral/cirugía , Oseointegración , Prótesis e Implantes , Tantalio , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de PrótesisRESUMEN
La resuperficialización de la cadera en pacientes jóvenes con necrosis avascular es una novedosa técnica quirúrgica que ofrece marcadas ventajas comparadas con las técnicas convencionales de reemplazo total de cadera. Se trata una paciente del sexo femenino de 21 años de edad que sufrió en un accidente de transito en febrero de 2004 con una fractura del cuello femoral por lo que se intervino quirúrgicamente con el sistema intercompresivo de Richards. Dos años más tarde se le diagnosticó una necrosis avascular de la cadera contra lateral por lo que se le realizó una resuperficialización de cadera metal-metal(AU)
Hip resurfacing in youngest patients is an excellent surgical technique for avascular necrosis compare with a traditional total hip replacement. Case presentation of a 21 years old female patient involved in a car accident in February 2004 with fracture of the neck of femur treated with compression hip screw Richards type. Two years later the patient was diagnosed with avascular necrosis of the contra lateral hip. Hip resurfacing metal-metal was carry out in the above mentioned patient(AU)
Asunto(s)
Humanos , Femenino , Adulto , Prótesis de Cadera , Necrosis de la Cabeza Femoral/cirugía , Informes de CasosRESUMEN
AIM: Mid-term result documentation of ceramic-on-ceramic cementless total hip replacement. METHOD: From November 1998 to December 2005, 356 patients were submitted to 419 total hip arthroplasties of the hip with a cementless, ceramic-ceramic Bicontact/Plasmacup type of prosthesis. Patients were controlled in a consecutive prospective study. RESULTS: The average age of the patient group is 47.9 years, with an average follow-up of 48 months. There was no case with release of osteolysis of the acetabular or femoral components. There was one ceramic head fracture in an obese patient. Articular wear was negligible and could not be measured radiographically. CONCLUSION: The ceramic-ceramic Bicontact hip joint replacement presents a low complication rate in young patients, with very low wear.
Asunto(s)
Cerámica , Prótesis de Cadera , Adolescente , Adulto , Anciano , Cementación , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/lesiones , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/cirugía , Estudios de Seguimiento , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Radiografía , ReoperaciónRESUMEN
We present the case of a 60-year-old man who had metastasis of a nodular squamous cell carcinoma from a laryngeal carcinoma that mimicked an infected sinus in a 4-month postoperative revision total hip arthroplasty scar. A diagnosis was made at the time of frozen section. The patient died 3 months after tumor resection as a result of multiorgan failure. Nodular squamous cell carcinoma metastasis in a total hip arthroplasty scar is extremely uncommon. However, this association must be considered in a patient with a known tumor after revision surgery. In such patients, we recommend obtaining an intraoperative frozen section to avoid misdiagnosis in cases of infected sinuses associated with implants.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Carcinoma de Células Escamosas/diagnóstico , Cicatriz/patología , Necrosis de la Cabeza Femoral/cirugía , Neoplasias Laríngeas/patología , Infecciones Relacionadas con Prótesis/diagnóstico , Neoplasias Cutáneas/diagnóstico , Carcinoma de Células Escamosas/secundario , Cicatriz/etiología , Diagnóstico Diferencial , Resultado Fatal , Secciones por Congelación , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Neoplasias Cutáneas/secundarioRESUMEN
Introduccion: El presente trabajo es un estudio prospectivo, no comparativo, que tiene por objeto evaluar los resultados obtenidos empleando la descompresión del núcleo cefálico con técnica de perforacion-forage aislada en los estadios iniciales de la necrosis aséptica (NA) de la cabeza femoral no traumatica y determinar su eficacia a largo plazo. Materiales y métodos: Desde junio de 1997 hasta junio de 2002 se trataron 56 caderas en 47 pacientes con NA de la cabeza femoral, agrupados por la clasificacion de Arlet y Ficat, modificada por Steinberg. Se incluyeron 32 varones y 15 mujeres, con una edad promedio de 39,6 años. Dieciocho pacientes presentaron enfermedad bilateral (11 eran asintomaticos). La tecnica quirurgica empleada, en todos los casos, fue la descompresion del núcleo cefalico aislada. Resultados: El seguimiento minimo fue de 30 meses (rango, 85-30 meses). Los pacientes fueron evaluados segun el puntaje de Harris (preoperatorio: 53 ± 14; posoperatorio: 79 ± 15). Se considero exito del tratamiento descompresivo cuando el paciente durante el seguimiento no requirió un segundo procedimiento terapeutico, conservo su cadera y realiza su actividad habitual sin dolor o con minimas molestias. Se obtuvo un resultado exitoso en 19 caderas del estadio I (82,61 por ciento), en 8 del estadio IIA (72,73 por ciento), en 5 del estadio IIB (55,56 por ciento), en 2 del estadio IIC (28,57 por ciento) y solo en 1 del estadio IIIA (16,66 por ciento). Conclusiones: La descompresion del nucleo cefalico es un procedimiento seguro, simple y de baja morbilidad que permite obtener un resultado significativo cuando se la utiliza en estadios iniciales del tratamiento de la NA no traumatica. Por lo tanto, para optimizar sus resultados es indispensable su pronto diagnostico y tratamiento, ya que su pronóstico es ostensiblemente mejor cuando se tratan lesiones pequeñas y en estadios precolapso de la cabeza femoral. (AU)