RESUMO
The Bernese periacetabular osteotomy (PAO) is a surgical procedure used to treat hip dysplasia in young adults, but it carries the risk of neurological complications, including injury to the motor ascending branch of the rectus femoris (MABRF). This study aimed to describe anatomical considerations to prevent MABRF injuries during PAO. A cadaveric study was conducted on seven specimens. The original and modified PAO approaches were used, with and without disinsertion of the rectus femoris muscle origin. The femoral nerve was dissected in all specimens from the endopelvic position to the MABRF origin (T-point). The average distance from the anterosuperior iliac spine to the T-point was 10.2 ± 0.4 cm. To protect the MABRF, a safety zone was identified for the osteotome placement during the ischial cut. The osteotome was slid over the joint capsule, deflecting the iliocapsularis muscle medially and distally. This manoeuvre shields the MABRF with the iliocapsularis muscle, reducing the risk of neurological injury. Both the original and modified PAO approaches were considered safe techniques with low risk to the rectus femoris innervation. These findings offer valuable insights for surgeons performing PAO, emphasizing the significance of understanding anatomical relationships and implementing protective measures to enhance patient outcomes and minimize complications. In conclusion, implementing these anatomical considerations can help prevent MABRF injuries during PAO, contributing to safer and more successful surgical interventions for hip dysplasia in young adults.
RESUMO
PURPOSE: This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). METHODS: This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. RESULTS: We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. CONCLUSION: A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. LEVEL OF EVIDENCE: IV.
RESUMO
Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19-31), 96% females. Mean follow-up 7 years (range: 3-16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.
RESUMO
The mechanical characterization of plain foamed concrete (PFC) and fiber-reinforced foamed concrete (FRFC) with a density of 700 kg/m3 was performed with compression and tension tests. FRFC was reinforced with the natural fiber henequen (untreated or alkaline-treated) at volume fractions of 0.5%, 1% and 1.5%. Polypropylene fiber reinforcement was also used as a reference. For all FRFCs, the inclusion of the fibers enhanced the compressive and tensile strengths and plastic behavior, which was attributed to the increase of specimen integrity. Under compressive loading, after the peak strength, there was no considerable loss in strength and a plateau-like regime was observed. Under tensile loading, the fibers significantly increased the tensile strength of the FRFCs and prevented a sudden failure of the specimens, which was in contrast to the brittle behavior of the PFC. The tensile behavior enhancement was higher when treated henequen fibers were used, which was attributed to the increase in the fiber-matrix bond produced by the alkaline treatment. The microscopic characterization showed that the inclusion of fibers did not modify the air-void size and its distribution. Higher energy absorption was observed for FRFCs when compared to the PFC, which was attributed to the enhanced toughness and ductility by the fibers. The results presented herein warrant further research of FRFC with natural henequen fibers for engineering applications.
RESUMO
PURPOSE: To determine the incidence of and factors that contribute to the development of hypothermia during hip arthroscopic surgery. METHODS: An analytic observational study was carried out in a cohort of 73 consecutive patients. All patients underwent hip arthroscopy for the treatment of femoroacetabular impingement. The patients' core temperature (esophageal) was measured throughout the surgery. Relevant information was collected on the patients (age, gender, body mass index, blood pressure) and on the procedure (volume and temperature of saline solution, pressure of fluid pump, surgery time, room temperature). The corresponding statistical analysis was performed with Stata 10.0 (StataCorp, College Station, TX), by use of a repeated-measures generalized estimating equations model. RESULTS: The patients' mean age was 33 years, and there were 39 female and 34 male patients. The mean body mass index was 23.9; systolic blood pressure, 97.5 mm Hg; and diastolic blood pressure, 52.2 mm Hg. The incidence of hypothermia below 35°C (95°F) was 2.7%. The multivariate statistical analysis of the results showed a direct relation between hypothermia and surgery time of more than 120 minutes (P < .001). There was an inverse relation between core body temperature and surgery time (P < .001), with a drop of 0.19°C/h (32.342°F/h). Of the patients, 68.22% had a decrease in temperature of more than 0.5°C (32.9°F) until the end of surgery. There was also a direct relation between core body temperature and saline solution temperature (P < .001), body mass index (P < .01), and diastolic blood pressure (P < .03). CONCLUSIONS: The incidence of hypothermia below 35°C (95°F) in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement is 2.7%. The factors that contribute toward the development of hypothermia during hip arthroscopic surgery are prolonged surgery time, low body mass index, low blood pressure during the procedure, and low temperature of the arthroscopic irrigation fluid.
Assuntos
Artroscopia , Impacto Femoroacetabular/cirurgia , Hipotermia/etiologia , Complicações Intraoperatórias/etiologia , Adolescente , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Hipotermia/epidemiologia , Incidência , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Fatores de Risco , Cloreto de Sódio , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: The goal of this study was to compare open and arthroscopic surgical techniques for "cam-type" femoroacetabular impingement in terms of feasibility and reliability. METHODS: We used 5 fresh-frozen cadaver specimens (10 hips). Anteroposterior and cross-table radiographs were taken for each. The head-neck union diameter was measured for each. The amount of bone resection at the anterolateral quadrant of the head-neck union was planned for each, with specific references to width, length, depth, and position. One side was randomly assigned to the open group and the other to the arthroscopic group. Surgical time, position of the osteotomy, and variation of the length, width, and depth of the final osteotomy with respect to the proposed dimensions were compared. RESULTS: In all specimens partial resection of the anterior-lateral femoral head-neck junction with improvement of the femoral head-neck offset was accomplished. A statistically significant difference (P < .05) was observed for surgical time between the open and arthroscopic groups (shorter in open group). CONCLUSIONS: When comparing surgical precision, no statistically significant differences were found between the open and arthroscopic procedures in any of the measurements. The depth and width of the osteoplasty were reliably obtained by the arthroscopic technique. However, there was a tendency to underestimate the osteoplasty length with the arthroscopic procedure. Positioning the osteoplasty was also less reliable with the arthroscopic procedure than with the open procedure because of the tendency to place the osteoplasty more posterior and distally than intended. CLINICAL RELEVANCE: Surgical resection of the femoral neck prominence and/or part of the anterolateral neck has been reported to improve femoral head offset and alleviate impingement. This study attempts to document the accuracy of this resection when done arthroscopically compared with an open procedure.