Revista Latinoamericana de Cirugía Ortopédica最新文献

Objective

To evaluate the clinical results, complications, and conversions to total knee replacement after distal femoral varus osteotomy.

Material and methods

A total of 36 patients with a mean age of 49 years were evaluated according to the Hospital Special Surgery (HSS) scale. Osteotomy failure was considered if conversion to total knee replacement was required, or when a clinical assessment below 70 was obtained. In all cases, a steel Puddu plate was used with iliac crest allograft support.

Results

The mean follow-up was 55 months, with an initial valgus alignment of 10.3^o. The final mean angulation was –0.3^o (varus), and the mean correction was 9.97^o. One patient required a total knee replacement. The survival of the osteotomies was 100% at 5 years, and 83.3% at 10 years. A score of 83.2 was obtained on the HSS scale. The osteosynthesis material had to be removed in three patients. One case failed and required a conversion to total arthroplasty.

Conclusions

The use of this technique for the correction of misalignments, its low rate of complications, and its good clinical outcomes makes distal femoral varus osteotomy an effective treatment for patients with symptomatic genu valgum.

Treatment of hip cartilage disease is challenging and there is no clear algorithm to address this condition. Biomarkers are emerging as promising diagnostic tools, as they could play a role in the early assessment of the pre-arthritic joint, as well as a prognostic factor before and after surgical or biological treatment. A trend towards a less invasive biological treatment is promising. With the growth of surgical skills in hip arthroscopy, cartilage restoration techniques are evolving in a fast and exponential manner. The purpose of this paper was to review new evidence available on the treatment options for chondral lesions and early osteoarthritis of the hip.

Objective

To describe the terrible tetrad and treatment algorithm in patients and cadaver models to differentiate it from other entities that affect the distal elbow complex and the differences in their treatment.

Material and methodology

We studied 7 patients (5 women and 2 men) with a mean age of 51 years, who had had posterior or posterolateral elbow dislocation associated with fracture of coronoid process, radial head and olecranon. We reproduced the lesional association tetrad in 3 cadaveric specimens. Treatment included the reduction and stabilization of the coronoid process. We appreciate the clinical results with Broberg and Morrey scales and DASH.

Results

Of the 7 patients who underwent surgery, 4 had to be re-operated. The average functional outcome with Broberg and Morrey scale was fair, 77 (96-38) points, and the DASH was 30 (78-10). The range of flexion and extension was 96° (range 120-45°) and pronosupination of 126° (range 150-40°), mean supination of 57° (range 70-40°) and pronation 48.5° (range 60-30°).

Conclusion

In the terrible elbow tetrad the main challenge is the correct preoperative diagnosis and good results are obtained with a stable elbow through proper surgical planning, individualizing rebuilding and repairing articular surfaces and ligamentous structures in a single approach.

Objective

To prove the cancellous bone allograft augmentation efficacy, when the lag screw of the dynamic condylar screw is used at the distal femoral end.

Materials and methods

Ten knees of 5 cadaveric models were used to implant the dynamic condylar lag screw; the torque of the screw was quantified during the implantation. Then we proceed to generate a lack of fixation based on an axial compression implantation of the lag screw. The screw was removed and the augmentation technique with cancellous bone allograft performed, then we measure again the torque needed on the lag screw implantation. We proceed on the same way after generate a total loose of fixation based on an excessive reaim with a 13 mm reamer.

Results

The final maximum torque average at the primary screw implantation was 60 kg/cm². This augmentation technique improved the fixation in 10% roughly when it was used on the second implantation, and when we generate a worst situation based on an excessive reaim, the fixation obtained was 70% of the primary screw fixation force.

Conclusion

The cancellous bone allograft augmentation is a biological technique that demonstrated an improvement on the lag screw fixation, even in the worst bone structural deficit situations.

Biopsy is a significant step in the diagnosis of a bone or soft tissue tumor. It is not a simple procedure. The purpose of this article is to offer some suggestions to physicians who care for such patients, to assistance them in avoiding the hazards inherent in the biopsy procedure. Decisions concerning the indication for biopsy, the exact region of the lesion that has to have a biopsy and the anatomic approach and biopsy procedure can make the difference between an efficacious biopsy and a disaster. Plan the biopsy procedure as carefully as the definitive surgery. If the orthopaedic surgeon or the institution is not equipped to accomplish accurate diagnostic studies or definitive surgery and/or adjunctive treatment, the patient should be referred to center, which has experience of these types of neoplasms and equipped with multidisciplinary team prior to performance the biopsy.

Introduction

Rotating-platform knee prosthesis were design to reduce contact stress of the implants and to increase the durability of implants.

Objective

To report the clinical outcomes of a consecutive series of patients who underwent primary rotating-platform knee arthroplasty, with a mean follow-up of 94 months.

Material and method

From 2003 to 2010, 75 total knee replacements were performed with Low Contact Stress (LCS^®) rotating-platform prosthesis. Painful knee osteoarthritis was the main diagnosis. Mean follow-up was 94 (60-118) months. Preoperatively, 64 knees had varus angulation (mean: 169°) and eleven knees had valgus angulation (mean: 187.8°). Patients were evaluated with the Hospital for Special Surgery (HSS) score at 1, 12, 36 and 60 months postoperatively.

Results

Two intraoperative partial patella tendon avulsions (2.6%) were diagnosed. Six knees showed loosening of the tibial component (8%) and four (5.3%) required revision. Two chronic infections (2.6%) were successfully managed. No polyethylene dislocation (spin-out) was observed. The mean preoperative HSS score was 44.6 points, which improved to 86.9 points at the end of the follow-up (P < 0.001).

Conclusion

Our study showed good survivorship and functional results of rotating-platform knee replacement at a mean follow-up of 94 months, similar to results of conventional fixed-bearing TKA.

Level of evidence

IV.