RESUMO
Femoral neuropathy is an uncommon yet debilitating complication of total hip arthroplasty (THA). Over a 1-year period, in 440 consecutive THAs performed at Pennsylvania Hospital, 10 (2.3%) femoral neuropathies occurred. Among primary arthroplasties, all neuropathies were associated with the Hardinge anterolateral approach. A retrospective case review as well as a detailed anatomic cadaveric study highlighted the characteristics of the femoral nerve that make it susceptible to injury. In addition, a review of the existing literature on this subject was performed. Placement and management of acetabular retractors were the factors most commonly associated with injury of the femoral nerve. All affected patients had significant initial disability. However, full femoral nerve. All affected patients had significant initial disability. However, full functional recovery occurred within 1 postoperative year. Clear understanding and awareness of the anatomy of the femoral triangle as well as accurate placement of anterior acetabular retractors can minimize the incidence of this complication.
Assuntos
Nervo Femoral/lesões , Prótese de Quadril/efeitos adversos , Feminino , Nervo Femoral/patologia , Prótese de Quadril/métodos , Humanos , Masculino , Osteoartrite/cirurgia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/patologia , Período Pós-Operatório , Reoperação , Estudos RetrospectivosRESUMO
The present study prospectively evaluated patient-controlled analgesia (PCA) in 94 postoperative primary total joint patients. Total knee arthroplasty patients had significantly higher pain scores than those undergoing total hip arthroplasty. Trochanteric osteotomy patients used less morphine (mean, 37.6 mg) than those undergoing a muscle-splitting (Hardinge) approach. Eighty-eight percent of patients would use PCA again. The authors recommend PCA as a potentially superior form of postoperative pain control in joint arthroplasty patients, but recommend antiemetic usage, generous additional intravenous administration of bolus doses on the floor, trials of higher set doses, and earlier administration of PCA in the recovery room.
Assuntos
Analgesia Controlada pelo Paciente , Prótese Articular , Dor Pós-Operatória/tratamento farmacológico , Idoso , Prótese de Quadril/efeitos adversos , Humanos , Prótese do Joelho/efeitos adversos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/efeitos adversos , Cuidados Pós-Operatórios , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
The authors have noted a change in the varus/valgus positioning of femoral components on anteroposterior (AP) radiographs that is dependent on limb rotation after total hip arthroplasty (THA). This effect, called pseudoposition, was demonstrated in six cadaver femurs implanted with an uncemented prosthesis that is noncanal-filling in the AP dimension. The distal tip of the prosthesis was positioned posteriorly in all specimens due to the bow of the femur. External rotation causes pseudovalgus positioning, and internal rotation causes pseudovarus positioning. Awareness of this phenomenon is important in the longitudinal analysis of femoral components after THA and emphasizes the need for standardized radiographic technique.
Assuntos
Fêmur/diagnóstico por imagem , Prótese de Quadril , Rotação , Prótese de Quadril/efeitos adversos , Prótese de Quadril/métodos , Humanos , Postura , Radiografia , Reprodutibilidade dos TestesRESUMO
A collarless wedge-shaped implant was inserted with cementless technique in seven fresh-frozen adult femora. Micromotion of the implant in the proximal femur was evaluated by applying an axial load of 3,000 N or a rotational force of 12 Nm. Six femurs were prepared using a cemented implant, and their stability was similarly determined for comparative purposes. In all tests, the amount of plastic deformation after load relief was quantitated. The cementless prosthesis had excellent initial stability with axial and rotational loading; also the micromotion was similar to that of the cemented implant. Deformation under these experimental conditions was predominantly elastic. The stability demonstrated with this cementless prosthesis satisfies the conditions necessary for bone ingrowth in vivo.
Assuntos
Prótese de Quadril/instrumentação , Adulto , Estudos de Avaliação como Assunto , Fêmur , Humanos , Movimento (Física) , Osseointegração , Desenho de Prótese , Estresse MecânicoRESUMO
The clinical and biochemical features of an infant affected by holocarboxylase synthetase deficiency are presented. The patient was the sibling of the deceased child in whose cultured skin fibroblasts the precise enzymatic disorder was first determined. This fact permitted administration of specific therapy in the form of oral biotin, resulting in immediate improvement from impending respiratory failure and shock. The clinical response to biotin was accompanied by recovery of the biochemical mechanisms known to be biotin-dependent, as manifested by disappearance of intermediates in urine and blood. The variability of biotin responsiveness and the diversity of clinical presentation in the patients originally thought to have a deficiency of beta methylcrotonylCoA carboxylase, a biotin-dependent enzyme, raises the question of a separate, specific apocarboxylase defect.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/etiologia , Biotina/uso terapêutico , Carbono-Nitrogênio Ligases , Ligases/deficiência , Aminoacidúrias Renais/etiologia , Erros Inatos do Metabolismo dos Aminoácidos/tratamento farmacológico , Aminoácidos/sangue , Aminoácidos/líquido cefalorraquidiano , Apoproteínas/deficiência , Apoproteínas/metabolismo , Biotina/deficiência , Biotina/metabolismo , Cromatografia por Troca Iônica , Humanos , Lactente , Recém-Nascido , Ligases/metabolismoRESUMO
The therapeutic efficacy of oral glycine was tested in a 3-year-old girl with isovaleric acidemia. An oral leucine load (25 mg/kg) caused a rise of the blood levels of isovaleric, lactic, and pyruvic acids as well as an increase of urinary excretion of the ketone bodies. These changes did not occur when oral glycine (250 mg/kg) was given with the leucine. Glycine supplementation favored the formation of isovalerylglycine, a nontoxic conjugate of isovaleric acid which is excreted rapidly. Excretion of isovalerylglycine rose threefold when leucine and glycine were administered simultaneously. Chronic glycine therapy was tolerated well and may have prevented one episode of ketoacidosis.