Bipolar revision arthroplasty for failed threaded acetabular components: radiographic evaluation of cup migration

Background:two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer.Methods:Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28%vs33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28%vs55%, respectively).Results:Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80.Conclusions:In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.

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3D MODELLING AND PRINTING IN PRIMARY AND REVISION ARTHROPLASTY

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2018-2-21-29 ◽

2018 ◽

Vol 25 (2) ◽

pp. 21-29 ◽

Cited By ~ 1

Author(s):

N. V. Zagorodniy ◽

G. A. Chragyan ◽

O. A. Aleksanyan ◽

S. V. Kagramanov ◽

E. V. Polevoy

Keyword(s):

Revision Arthroplasty ◽

3D Modelling ◽

Pelvic Bone ◽

Type I ◽

Biological Fixation ◽

Surgical Interventions ◽

Custom Made ◽

Paprosky Classification ◽

Acetabular Defects ◽

Acetabular Components

Introduction. Acetabular arthroplasty in patients with the abnormal pelvic bone anatomy is a challenging task. In recent years the method of 3D modelling and printing of custom acetabular components is widely used at acetabular arthroplasty in patients with marked bone defects.Purpose of study: to evaluate the accuracy, convenience of the positioning and efficacy of the primary stabilization of custom acetabular components in patients with bone defects at primary and revision hip arthroplasty. Patients and methods. Eighteen surgical interventions using 3D modelling and printing, i.e. 12 for hip instability, 6 — for posttraumatic coxarthrosis were performed. The study included 9 women and 9 men with mean age 60.9±15.8 years. By Paprosky classification in 2 cases the defects corresponded to Type I, in1 case — Type IIA, in 4 cases — Type IIB (posttraumatic coxarthrosis), in 2 cases — Type IIIA, in 10 — Type IIIB out of them 2 cases with pelvic bone separation. Custom components were produced using the method of direct metal laser sintering (DMLS). The whole technologic process took from 4 to 8 weeks and was conducted jointly with the engineers. Results. Exact match of implant form and the defect was observed in 89.9% of cases. In 2 patients with pelvic bone separation additional correction of bone structures was required when placing the acetabular component. In radiograph from 2 to 8 months after surgery the constructions were stable.Conclusion. 3D technology for the custom-made acetabular components is a method of resolving the problem in patients with marked acetabular defects. It enables to plan the surgery, simplifies the choice for screws positioning avoiding their interference. The design features of the implant are three rigid flanges with screw holes that create additional contact with intact parts of the ischial, iliac and pubic bones. Screw fixation ensures initial rigid stability until the biological fixation is achieved.

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Motion Analysis of the Cervical Spine

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2004.sepoct01 ◽

2004 ◽

Vol 9 (5) ◽

pp. 1-11

Author(s):

Patrick R. Luers

Keyword(s):

Cervical Spine ◽

Intervertebral Disk ◽

Radiographic Evaluation ◽

Ligamentous Injury ◽

Pattern Of Injury ◽

Motion Segment ◽

Single Pattern ◽

Compensatory Motion ◽

Loss Of Motion ◽

Flexion And Extension

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

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Dynamic Proximal Ulnar Osteotomy for the Treatment of Ununited Anconeal Process in 17 Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632614 ◽

1998 ◽

Vol 11 (02) ◽

pp. 76-79 ◽

Cited By ~ 14

Author(s):

B. M. Turner ◽

R. H. Abercromby ◽

J. Innes ◽

W. M. McKee ◽

M. G. Ness

Keyword(s):

Clinical Outcome ◽

Prospective Study ◽

Patient Population ◽

Clinical Results ◽

Radiographic Evaluation ◽

Proximal Ulna ◽

Ulnar Osteotomy ◽

A Prospective Study

SummaryA prospective study was made of 17 dogs with ununited anconeal process treated by osteotomy of the proximal ulna. The effect of the surgery on lameness was evaluated subjectively and the elbows were assessed radiographically for evidence of anconeal fusion and healing of the osteotomy. Whilst clinical outcome was generally good and complications infrequent, relatively few cases achieved anconeal fusion. These results do not compare well with the results of a previous study but this disparity may be due in part to differences in patient population and radiographic evaluation.Further work is required to establish how best to achieve predictable anconeal fusion.Proximal ulnar osteotomy was used to treat 17 dogs with ununited anconeal process. Clinical results were good but anconeal fusion was not achieved consistently. Further work is needed to determine how best to achieve predictable anconeal fusion.

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The Repair and Healing of Two Traumatic Ilial Body Fractures Adjacent to Cemented Total Hip Acetabular Components

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633073 ◽

1992 ◽

Vol 05 (02) ◽

pp. 85-89

Author(s):

P. K. Shires ◽

T. L. Dew

Keyword(s):

Internal Fixation ◽

Cancellous Bone ◽

Surgical Techniques ◽

Autogenous Bone ◽

Cancellous Bone Graft ◽

Standard Methods ◽

Intravenous Antibiotics ◽

Prophylactic Use ◽

Acetabular Components ◽

Autogenous Bone Grafts

SummaryThis report has documented the repair and healing of two ilial fractures in dogs which were compounded by the presence of a cemented acetabular prosthesis. While specific recommendations can not be made from such a small number of cases, the information presented herein suggests that such fractures will heal without complication if aseptic surgical techniques and standard methods of internal fixation are employed. The authors strongly recommend the prophylactic use of intravenous antibiotics and the placement of cancellous bone graft when the repair of such fractures is attempted.Two traumatic ilial fractures involving the cement/bone interface of acetabular prostheses were repaired using lag screws, cerclage wires, and autogenous bone grafts. The fractures healed and ambulatory function was regained.

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Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632495 ◽

1996 ◽

Vol 09 (01) ◽

pp. 10-3 ◽

Cited By ~ 2

Author(s):

D.N. Aron ◽

R. Roberts ◽

J. Stallings ◽

J. Brown ◽

C.W. Hay

Keyword(s):

Articular Surface ◽

Cruciate Ligament ◽

Positive Contrast ◽

Joint Effusion ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Joint Pathology ◽

Meniscal Pathology ◽

Cranial Cruciate Ligament Disease ◽

Better Than

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

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PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.85 ◽

2018 ◽

Vol 1 (2) ◽

pp. 7

Author(s):

Jun Ho Lee

Keyword(s):

Lumbar Disc ◽

Lumbar Discectomy ◽

Radiographic Evaluation ◽

Operative Indication ◽

Endoscopic Techniques ◽

Bone Removal ◽

Iatrogenic Trauma ◽

Minimal Damage ◽

Surgical Modality ◽

Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of full-endoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion.Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root.Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID.

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