scholarly journals MRI-biochemical follow up measurements of lumbar intervertebral disc in patients with leg length discrepancy: Is it possible to alter cartilage damage with conservative therapy?

2019 ◽  
Vol 16 (6) ◽  
pp. 473-477
Author(s):  
Miriam Frenken ◽  
David Latz ◽  
Erik Schiffner ◽  
Wolfgang Alois Quante ◽  
Maxime Knautz ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Conservative Therapy ◽  
Cartilage Damage ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Lumbar Intervertebral Disc ◽  
Length Discrepancy

Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses

2018 ◽  
Vol 100-B (12) ◽  
pp. 1640-1646 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. Clark ◽  
L. M. Jeys
Keyword(s):  
Minimally Invasive ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Range Of Movement ◽  
Musculoskeletal Tumor Society ◽  
Non Invasive ◽  
Length Discrepancy ◽  
The Mean

AimsThe aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.Patients and MethodsA total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.ResultsThe overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).ConclusionThe survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

scholarly journals Osteonecrosis of the Femoral Medial Condyle Due to Leg Length Discrepancy After A Traffic Accident

2020 ◽  
Vol 14 (1) ◽  
pp. 135-139
Author(s):  
Wataru Kusano ◽  
Takatomo Mine ◽  
Koichiro Ihara ◽  
Hiroyuki Kawamura ◽  
Michio Shinohara ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Traffic Accident ◽  
Cartilage Damage ◽  
Leg Length Discrepancy ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Leg Length ◽  
Medial Condyle ◽  
Length Discrepancy ◽  
Spontaneous Osteonecrosis

Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.

scholarly journals Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

2020 ◽  
Author(s):  
Zhenzhong Li ◽  
Congcong Wei ◽  
Xiangke Li ◽  
Mengxuan Yao ◽  
Huijie Li
Keyword(s):  
Total Hip Arthroplasty ◽  
Septic Arthritis ◽  
Pain Score ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Two Stage ◽  
Length Discrepancy ◽  
The Mean

Abstract Background To compare the outcomes of debridement and antibiotic-loaded spacer implantation in primary advanced septic arthritis (SA) of the hip in adults treated with two-stage total hip arthroplasty (THA). Methods In the first stage, 9 patients were treated with debridement and 11 patients were treated with antibiotic-loaded spacer implantation. Then, THA was conducted in all patients in the second stage. Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score and leg-length discrepancy. Results No cases of infection, deep vein thrombosis, death, and loosening of hip prosthesis were observed during follow-up. The mean follow-up time was 29.09 ± 10.80 months in the debridement with THA group, and 28.22 ± 14.80 months in the spacer implantation with THA group. Before the THA surgery, the mean leg-length discrepancy was 2.80 ± 2.03 cm in the debridement with THA group, and 0.50 ± 0.23 cm in the spacer implantation with THA group (P < 0.05). In the latest follow-up, The Harris hip scores of patients was 90.33 ± 4.85 in the debridement with THA group and 94.36 ± 2.34 in the spacer implantation with THA group (P < 0.05), respectively. There was no statistical significant difference in VAS pain score of the hip between the two groups (P > 0.05).Conclusions Two-stage THA using antibiotic-loaded spacer implantation is an effective method for the treatment of advanced SA of the hip in adults due to it can control infection and significantly improve functional hip.

The use of a non-invasive extendable prosthesis at the time of revision arthroplasty

2018 ◽  
Vol 100-B (3) ◽  
pp. 370-377 ◽  
Author(s):  
M. M. Gilg ◽  
C. L. Gaston ◽  
L. Jeys ◽  
A. Abudu ◽  
R. M. Tillman ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Revision Procedure ◽  
Length Discrepancy ◽  
Prosthesis Revision ◽  
The Mean ◽  
Primary Bone Tumours

Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370–7.

scholarly journals Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1152
Author(s):  
Maurizio De Pellegrin ◽  
Lorenzo Brogioni ◽  
Guy Laskow ◽  
Graziano Barera ◽  
Roberta Pajno ◽  
...  
Keyword(s):  
Genetic Disorder ◽  
Case Series ◽  
Invasive Procedure ◽  
Leg Length Discrepancy ◽  
Vascular Lesions ◽  
Abdominal Wall Defects ◽  
Leg Length ◽  
Guided Growth ◽  
Length Discrepancy

Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.

scholarly journals Temporary Proximal Tibial Epiphysiodesis for Correction of Leg Length Discrepancy in Children—Should Proximal Fibular Epiphysiodesis Be Performed Concomitantly?

2021 ◽  
Vol 10 (6) ◽  
pp. 1245
Author(s):  
Adrien Frommer ◽  
Maike Niemann ◽  
Georg Gosheger ◽  
Maria Eveslage ◽  
Gregor Toporowski ◽  
...  
Keyword(s):  
Reference Values ◽  
Implant Removal ◽  
Leg Length Discrepancy ◽  
Fibular Head ◽  
Leg Length ◽  
Proximal Fibula ◽  
Length Discrepancy ◽  
Radiographic Measurements ◽  
Peroneal Nerve Injury

The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values.

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