scholarly journals The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tingxian Ling ◽  
Zichuan Ding ◽  
Mingcheng Yuan ◽  
Kai Zhou ◽  
Zongke Zhou
Keyword(s):  
Demographic Data ◽  
Hip Dislocation ◽  
Clinical Results ◽  
Safe Zone ◽  
Consecutive Series ◽  
Anterior Hip Dislocation ◽  
Safe Zones ◽  
Cup Positioning ◽  
Transverse Acetabular Ligament

Abstract Background Total hip arthroplasty (THA) candidates frequently present pelvic malrotation. The aim of this study is to analyze how pelvic malrotation influence transverse acetabular ligament (TAL) guided cup orientation and investigate whether pelvic malrotation produce different clinical outcomes after THA. Methods We retrospectively reviewed a consecutive series of THA patients (144 hips) who use TAL as a guidance for cup positioning from March 2017 to January 2020. The patients were divided into normal pelvis (NP) group and backward pelvis (BP) group by sagittal pelvic malrotation assessed by APPA, the angle between the vertical and the APP on standing lateral pelvic radiographs preoperatively. Cup anteversion and inclination and that out of the safe zones were measured and compared in two groups. The demographic data, clinical results, and complications of patients were also compared. Results Backward pelvic malrotation were found in 60.6 % of this cohort of THA candidates. The mean angle of both inclination and anteversion in BP group were significantly larger than that in NP group. The rate of cup for anteversion and inclination above the safe zone in BP group was significantly larger than that in NP group. There were 4 patients in BP group recording anterior hip dislocation after surgery. Other complications were not observed at last follow-up. Conclusions Backward pelvis malrotation may increase TAL guided cup inclination and anteversion, which were inclined to became outlier above the safe zone. This likely increase the rates of dislocation after THA. For the patients with pelvis malrotation, cup positioning should be performed individually instead of guided by TAL.

scholarly journals Adenosine-induced Asystole during AVM Embolization

2021 ◽  
Author(s):  
V. Hellstern ◽  
P. Bhogal ◽  
M. Aguilar Pérez ◽  
M. Alfter ◽  
A. Kemmling ◽  
...  
Keyword(s):  
Demographic Data ◽  
Clinical Results ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Residual Shunt ◽  
Grade 5 ◽  
Martin Grade ◽  
Grade 3 ◽  
Brain Avms

Abstract Background Adenosine induced cardiac standstill has been used intraoperatively for both aneurysm and arteriovenous malformation (AVM) surgery and embolization. We sought to report the results of adenosine induced cardiac standstill as an adjunct to endovascular embolization of brain AVMs. Material and Methods We retrospectively identified patients in our prospectively maintained database to identify all patients since January 2007 in whom adenosine was used to induce cardiac standstill during the embolization of a brain AVM. We recorded demographic data, clinical presentation, Spetzler Martin grade, rupture status, therapeutic intervention and number of embolization sessions, angiographic and clinical results, clinical and radiological outcomes and follow-up information. Results We identified 47 patients (22 female, 47%) with average age 42 ± 17 years (range 6–77 years) who had undergone AVM embolization procedures using adjunctive circulatory standstill with adenosine. In total there were 4 Spetzler Martin grade 1 (9%), 9 grade 2 (18%), 15 grade 3 (32%), 8 grade 4 (18%), and 11 grade 5 (23%) lesions. Of the AVMs six were ruptured or had previously ruptured. The average number of embolization procedures per patient was 5.7 ± 7.6 (range 1–37) with an average of 2.6 ± 2.2 (range 1–14) embolization procedures using adenosine. Overall morbidity was 17% (n = 8/47) and mortality 2.1% (n = 1/47), with permanent morbidity seen in 10.6% (n = 5/47) postembolization. Angiographic follow-up was available for 32 patients with no residual shunt seen in 26 (81%) and residual shunts seen in 6 patients (19%). The angiographic follow-up is still pending in 14 patients. At last follow-up 93.5% of patients were mRS ≤2 (n = 43/46). Conclusion Adenosine induced cardiac standstill represents a viable treatment strategy in high flow AVMs or AV shunts that carries a low risk of mortality and permanent neurological deficits.

Mid-Term Results of Ceramic-on-Ceramic Total Hip Arthroplasty with Sandwich Cup

2006 ◽  
Vol 309-311 ◽  
pp. 1357-1362
Author(s):  
Masahiro Hasegawa ◽  
Akihiro Sudo ◽  
Atsumasa Uchida
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Clinical Results ◽  
Total Hip ◽  
The Mean ◽  
Acetabular Components ◽  
Mid Term Results ◽  
Ceramic On Ceramic

In ceramic-on-ceramic total hip arthroplasty (THA), modular acetabular component with a sandwich insertion was developed and evaluated mid-term clinical results. 35 hips had undergone cementless ceramic-on-ceramic THA with sandwich cup (Kyocera, Kyoto, Japan). The mean duration of follow-up was 5 years. 6 hips had undergone component revisions. The reasons for revision included infection in 1 hip, dislocation with loosening in 2 hips, alumina liner fractures in 2 hips, and cup dissociation in 1 hip. All femoral and acetabular components showed no loosening in the unrevised hips at the time of the last follow-up. None of the 29 unrevised hips had osteolysis.

Good mid-term clinical results of a cemented dual mobility cup: a single-centre experience

2017 ◽  
Vol 28 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Gregor Kavčič ◽  
Pika Mirt ◽  
Klemen Bedenčič
Keyword(s):  
Final Analysis ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Single Centre Experience ◽  
The Mean ◽  
Hip Arthroplasties

Introduction and methods: From January 2004 to December 2008, 188 total hip arthroplasties were performed using a cemented dual mobility cup. 174 patients were available for final analysis. Their mean age was 76.8 (range 54-98 years). The mean follow-up was 7.7 years (range 5-10 years). Results: There were no dislocations. Survivorship rates of the femoral and acetabular components were 100% at a minimum of 5 years. At the latest follow-up, the mean Harris Hip Score significantly increased from 31.6 (only arthritic patients) points preoperatively to 84.5 points. No patients had progressive osteolysis, component migration, or loosening on radiographs. 2 patients presented with periprosthetic fractures treated conservatively. 2 patients presented with infection treated without implant removal and 1 patient presented with transient femoral palsy. Conclusions: The results of this consecutive series confirmed the good performance of the cemented dual mobility cup at mean 7.7 years follow-up with no revision and no dislocations.

Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

scholarly journals Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

2018 ◽  
Vol 2018 ◽  
pp. 1-12
Author(s):  
Carlo Biz ◽  
Marco Corradin ◽  
Wilfried Trepin Kuete Kanah ◽  
Miki Dalmau-Pastor ◽  
Alessandro Zornetta ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Predictive Value ◽  
Preoperative Planning ◽  
Callus Formation ◽  
Demographic Data ◽  
Percutaneous Technique ◽  
Consecutive Series ◽  
Metatarsal Bones

Background. The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods. A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p < 0.05). Results. Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p < 0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion. DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMMO.

Laser Transmyocardial Revascularization (TMLR) Combined with Autologous Bone Marrow Cells (ABMC) for Diffuse Coronary Disease (DCD). Results In 19 Cases

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1181-1181
Author(s):  
Adrian Alegre ◽  
Beatriz Aguado ◽  
M. Perez Alfonso ◽  
C. Muñoz ◽  
M. Ortiz de Landázuri ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Cellular Therapy ◽  
Bone Marrow Cells ◽  
Demographic Data ◽  
Autologous Bone Marrow ◽  
Clinical Results ◽  
Specific Cell ◽  
Transmyocardial Revascularization ◽  
Advanced Therapy

Abstract Abstract 1181 Introduction: Stem cells (SC) show a potential of cellular therapy in diffuse coronary disease with controverted results. We present here an analysis of a group of patients treated with TMLR plus ABMC. (Caiber Program Advanced Therapy Proyect FIS 2009). Patients and methods: 19 patients with DCD were included. Age 66 (range: 52–78). ABMC were obtained by aspiration and processed using HARVEST-TM system -TALEX (Harvest Technologies Inc. GMBH, Munich) to obtain 20 ml. Surgery consisted of anterior thoracotomy incision at the fourth and fifth intercostal space. Between 15–30 transmyocardial channels were realized with TLMR PHOENIX-TM (Cardiogenesis, Irvine, CA, USA) and CrystalFlex 1 mm optical fibre. 0.5–2 cc of MO were administered in each channel. Total number CMN were determined by automatic cell counter and flow cytometry and were typified specific cell populations such as CD34+ and CD133+. Results: The duration of stem cell collection was less than 30 minutes. All the procedure was performed on surgery in 1 step. Any complications were observed with this technique. Correlation between the cellular count and demographic data was not observed. After a follow up of 22 months (5-36) only one patient has died (20m) of DCD. Initial clinical results are satisfactory with a significant reduction in the functional grade of angina. Comments and conclusions: Our data show that TMLR plus ABMC is a safe method with clinical efficacy in patients with DCD that are not candidate to other therapy options. The described method offers efficiency and simplicity to obtain cells. More cases and follow-up are required, as well as later functional evaluations. Disclosures: Alegre: Celgene: Honoraria. Off Label Use: Lenalidomide is not approved for the treatment of smoldering multiple myeloma.

scholarly journals The management of Vancouver B1 and C periprosthetic fractures: radiographic and clinic outcomes of a monocentric consecutive series

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 94-100
Author(s):  
Vincenzo Ciriello ◽  
Roberto Chiarpenello ◽  
Alessandro Tomarchio ◽  
Francesco Marra ◽  
Antonio Carmine Egidio ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Demographic Data ◽  
Healing Time ◽  
Periprosthetic Fractures ◽  
Posterolateral Approach ◽  
Consecutive Series ◽  
Fracture Type ◽  
Type Of Fracture

Introduction: Periprosthetic fractures (PFs) are a main complication after total hip arthroplasty (THA), with rising incidence. The optimal treatment of PFs is still being debated in the literature. Historically, high failure and reoperation rates are reported, although the introduction of locking plates has led to improved results. In this study we report clinical and radiographic outcomes of a consecutive series of Vancouver B1 and C fractures, treated with a novel type of locking plate. We also aim to identify the variables associated with healing time. Methods: Between June 2013 and May 2019, 47 patients were consecutively admitted to the Emergency Department of our Hospital with a diagnosis of PF around a well-fixed THA stem. 31 patients fulfilled the inclusion criteria and were included in the study. All patients underwent osteosynthesis with a novel type of plate (“Ironlady” Intrauma, Rivoli, Italy) through a distally extended posterolateral approach. All surgical procedures were performed with the aim of reducing the rigidity of the fixation construct and preserving periosteal vitality. Demographic data, type of fracture, type of stem and its fixation, surgical details, and clinical and radiographical outcomes were recorded. Each variable was investigated to assess its relationship with fracture healing and healing time. Results: 31 patients were included in the study. 4 patients died before the minimum follow-up of 6 months and were excluded from the series. The final sample consisted of 27 patients. Their median age at operation was 84.8 years (range 65.3–95.4 years); 21 were female. The median follow-up after surgery was 2.36 years (range 6 months–4.7 years). In the cohort there were 22 type Vancouver B1 fractures (81.5%) and 5 type C (18.5%). All fractures occurred postoperatively (no acute intraoperative fractures). Fracture union was achieved in 26 patients (96.3%). The following variables were found to be associated with increased healing time: Vancouver type of fracture, pattern of Vancouver B1 fracture type, age and male gender. Conclusions: On the base of our results, the management of Vancouver B1 and C type of PFs by locking plate osteosynthesis appears to be a safe and effective procedure. To enhance healing and reduce complication rate, accurate surgical technique is required, aiming to implement the proximal fixation, avoid stress rising, reduce rigidity of the osteosynthesis construct and preserve the plate-to-bone gap.

The posterior acetabular wall (PAW): an aid to acetabular orientation at primary THA

2017 ◽  
Vol 28 (1) ◽  
pp. 29-32
Author(s):  
Huw L.M. Williams ◽  
Gavin E. Bartlett ◽  
Mark R. Norton ◽  
Rory G. Middleton
Keyword(s):  
Acetabular Component ◽  
Posterior Wall ◽  
Consecutive Series ◽  
Prospective Data ◽  
Radiographic Findings ◽  
Component Orientation ◽  
Cup Positioning ◽  
Cup Position ◽  
Acetabular Wall

Introduction: Incorrect acetabular component positioning during total hip arthroplasty (THA) may lead to dislocation, impingement, wear and revision. Surgeons commonly use the transverse acetabular ligament (TAL) as a landmark for acetabular component orientation. The posterior acetabular wall (PAW) is a structure easily viewed on plain radiography and its position can help guide acetabular component position. In this study, we examine the efficacy of preoperative radiographs in predicting cup position relative to the PAW. Methods: Prospective data was recorded on radiographic findings of the posterior wall (prominent, normal, deficient) on a consecutive series of 200 primary THAs utilising a standardised posterior approach. The final cup position relative to the wall was recorded (prominent, flush, deep). Cup inclination and version were then assessed by postoperative radiography and any instances of dislocation recorded. Results: There were 117 females and 83 males with a mean age of 66.5 years. 154 were recorded as having a normal PAW on radiographs, 152 had the cup positioned in line with the TAL and flush to the PAW. 29 had a deficient PAW and 27 of these had a cup positioned prominently with 17 having a prominent PAW and of these 16 a deep cup position. Postoperative radiographs showed a mean cup version of 20.8° and inclination of 44.7° using this method. There were 21 outliers (10.5%) with no dislocations at a minimum 12-month follow-up. Conclusions: The TAL is a continuation of the posterior labrum. As such, the posterior wall is a useful adjunct to and surrogate landmark for the TAL. It has the added advantage that it is visible on radiographs and so aids surgical planning with respect to cup positioning.

Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results

2010 ◽  
Vol 112 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Serge Bracard ◽  
Amr Abdel-Kerim ◽  
Lorrena Thuillier ◽  
Olivier Klein ◽  
René Anxionnat ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vegetative State ◽  
Clinical Results ◽  
Endovascular Coiling ◽  
Consecutive Series ◽  
Unruptured Aneurysms ◽  
Coil Occlusion

Object The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution. Methods The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered. Results At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years. Conclusions Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.

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