Retrieval and Radiographic Analysis of the Contour Antiprotrusio Cage

Introduction Acetabular reconstruction in the setting of severe bone loss or pelvic discontinuity remains a challenging problem. Multiple methods of treatment have been described including antiprotrusio cages (APCs). The objective of this study is to combine biomechanical analysis of retrieved APCs with radiographic and clinical data to determine which factors influence or predict APC failure. Methods 41 APCs were identified. Sequential radiographs were examined for cage and polyethylene cup abduction angles, change in centre of rotation, screw placement, progression of cage failure, and failure mechanism. Cages were manually examined for gross macroscopic findings, breakage, and the location of breakage. High-resolution microscopy was used for further analysis. Results 24 cages were included in the analysis. Mean age of patients was 64.5 years (range 43-85 years); average length of implantation was 42.5 months (range 3-108 months). Average cage abduction angles were 56°; abduction for the cemented polyethylene cup was 44°. 14 of 24 cages were broken; 10 were intact. Of the broken cages, 10/14 broke through a screw hole in the ischial flange or just superior to the ischial flange. In the intact group, 6/10 failed due to pullout of the ischial screws. Discussion All cages had superior and lateralised centres of rotation. The majority of cages failed due to breakage or pullout at the ischial flange. Pelvic discontinuity was a large risk factor for a broken cage. Future design and technique modifications may result in superior outcomes in these complex acetabular reconstructions.

Download Full-text

Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

Case Reports in Orthopedics ◽

10.1155/2011/939202 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Iori Takigami ◽

Yoshiki Ito ◽

Takashi Mizoguchi ◽

Katsuji Shimizu

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

Rare Complication ◽

Acetabular Reconstruction ◽

Fibular Graft ◽

Intraoperative Complication ◽

Pelvic Discontinuity ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA), typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

Download Full-text

Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

10.21203/rs.2.20213/v3 ◽

2020 ◽

Author(s):

Jing-yang Sun ◽

Ming Ni ◽

Hai-yang Ma ◽

Yin-qiao Du ◽

Jun-min Shen ◽

...

Keyword(s):

Perioperative Complications ◽

Vertical Direction ◽

Harris Hip Score ◽

Abduction Angle ◽

Acetabular Reconstruction ◽

Pelvic Discontinuity ◽

Long Term Prognosis ◽

Postoperative Dislocation ◽

Component Loosening

Abstract Background: The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods: This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum follow-up of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results: At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occurred. Conclusions: Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity, with encouraging results at early-term. However, ongoing follow-up is required to determine the long-term prognosis in patients receiving this technique.

Download Full-text

THE EVOLUTION OF TREATMENT AT THE ORTHOPEDICS AND REHABILITATION CLINIC

Wiadomości Lekarskie ◽

10.36740/wlek202009101 ◽

2020 ◽

Vol 73 (9) ◽

pp. 1815-1817

Author(s):

Joanna Niezbecka-Zając ◽

Karolina Turżańska ◽

Agnieszka Posturzyńska ◽

Anna Horecka

Keyword(s):

Waiting Time ◽

Average Length ◽

Chronically Ill ◽

Medical Progress ◽

Patient Profile ◽

Chronically Ill Patients ◽

Orthopedic Patients ◽

Rehabilitation Clinic ◽

Methods Of Treatment ◽

Length Of Hospitalization

Introduction: The last 20 years have been a period of huge changes in Polish healthcare, both in terms of medical progress as well as organization and financing. These changes, and especially the newly introduced queuing systems significantly influenced the changes in the profile of hospital admission. The aim: To analyze changes in the patient profile, causes and time of hospitalization, as well as the waiting time for hospitalization, in 1996-2019 Lublin SPSK4 Orthopedics and Rehabilitation Clinic. Material and methods: Patients’ medical records were analyzed, including qualification cards. The waiting time for admission to the hospital, the time of hospitalization, the cause of hospitalization, gender and the patient’s place of residence were analyzed. Results and conclusions: 1. During the 13 years analyzed, the number of hospitalizations increased from 452 to 1387 patients a year. 2. The waiting time for hospitalization increased from an average of 2 months in 1996 to even 2 years (in the case of patients with chronic category) in 2020. 3. The average length of hospitalization changed compared to the level of 1996 (8 weeks) in the case of patients with the early neurological category increased slightly (9 weeks), in the case of other patients - it decreased to 4 weeks, respectively - chronically ill patients, 3 weeks - patients from the systemic and weekly rehabilitation category - orthopedic patients. 4. The scope of the reasons for hospitalization, but also methods of treatment has expanded significantly. 5. Patient demographic profile in the examined aspects (origin, gender) - remained similar.

Download Full-text

Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

10.21203/rs.2.20213/v1 ◽

2020 ◽

Author(s):

Jing-yang Sun ◽

Ming Ni ◽

Hai-yang Ma ◽

Yin-qiao Du ◽

Jun-min Shen ◽

...

Keyword(s):

Perioperative Complications ◽

Vertical Direction ◽

Porous Metal ◽

Harris Hip Score ◽

Abduction Angle ◽

Acetabular Reconstruction ◽

Pelvic Discontinuity ◽

Postoperative Dislocation ◽

Component Loosening ◽

Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

Download Full-text

Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

Hip International ◽

10.1177/1120700018813208 ◽

2018 ◽

Vol 28 (2_suppl) ◽

pp. 66-72 ◽

Cited By ~ 4

Author(s):

Mattia Loppini ◽

Paolo Schiavi ◽

Antonello Della Rocca ◽

Francesco Traverso ◽

Federico Della Rocca ◽

...

Keyword(s):

Bone Defects ◽

Acetabular Reconstruction ◽

Trabecular Metal ◽

Acetabular Bone ◽

Pelvic Discontinuity ◽

Type Iii ◽

Heterotopic Ossifications ◽

Radiographic Outcomes ◽

Acetabular Bone Defects

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

Download Full-text

Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections

Sarcoma ◽

10.1155/2016/8627023 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Vivek Ajit Singh ◽

Hassan Elbahri ◽

Rukmanikanthan Shanmugam

Keyword(s):

Hip Replacement ◽

Biomechanical Analysis ◽

Acetabular Reconstruction ◽

Reconstruction Technique ◽

Type Ii ◽

Acetabular Cup ◽

Viable Option ◽

Load To Failure ◽

The Mean ◽

Biomechanical Strength

Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods.Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure.Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure.Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was1738.6±200.3 Nmm−1compared to the intact pelvis, which was911.4±172.7 Nmm−1(Pvalue = 0.01). The mean load to failure for the standard acetabular cup construct was3297.3±117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was4863.8±7.0 N.Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

Download Full-text

In Vitro Study of Biomechanical Analysis of Modified Lateral Lumbar Interbody Fusion—crenel Lumbar Interbody Fusion

10.21203/rs.3.rs-66916/v1 ◽

2020 ◽

Author(s):

Yun-lin Chen ◽

Ou-jie Lai ◽

Wei-hu Ma ◽

Yu-li Ma ◽

Jia-ni Pang ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

In Vitro Study ◽

Biomechanical Analysis ◽

Lumbar Interbody Fusion ◽

Lateral Plate ◽

Intact Group ◽

Plate Group ◽

Screw Group

Abstract Background To analyze the biomechanical stability of the modified LLIF, crenel lateral interbody fusion (CLIF), and compare various methods of instrumentation of CLIF in vitro.Methods Three fresh-frozen cadaveric lumbar spines (L1-S1) were used in our study. The modified CLIF interbody cage was inserted into the L3/4 level in each specimen. Every specimen was tested under 5 conditions: intact group; stand-alone CLIF group; CLIF with lateral plate group (CLIF + LP); CLIF with lateral plate and unilateral pedicle screw group (CLIF + LP + UPS); CLIF with bilateral pedicle screw group (CLIF + BPS).Results The ROM of each CLIF group was significantly reduced when compared with intact group in all directions of loading (p< 0.05). The CLIF + LP + BPS group was the most stable in all directions of loading. CLIF + LP group has less ROM when compared with stand-alone group except for the extension condition. CLIF + BPS group has less ROM than CLIF + LP group in every condition. Conclusions CLIF combine with lateral plate and bilateral pedicel screw is the most stable supplemental fixation, and lateral plate could reduce the ROM under rotation and lateral bending conditions. For patients with good bone quality, stand-alone with or without is a alternative method to achieve a good clinical result.

Download Full-text

Surgical treatment of liver echinococcosis

Perm Medical Journal ◽

10.17816/pmj38332-40 ◽

2021 ◽

Vol 38 (3) ◽

pp. 32-40

Author(s):

M. F. Zarivchatskiy ◽

I. N. Mugatarov ◽

E. D. Kamenskikh ◽

M. V. Kolyvanova ◽

N. S. Teplykh

Keyword(s):

Surgical Treatment ◽

Liver Resection ◽

Postoperative Complications ◽

Hospital Stay ◽

Average Length ◽

Enzyme Linked Immunosorbent Assay ◽

Percutaneous Puncture ◽

Echinococcal Cyst ◽

Duration Of Surgery ◽

Methods Of Treatment

Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy. Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection in 18 patients, anatomical liver resection in 14 patients, pericystectomy in 10, laparoscopic echinococectomy in 1, percutaneous puncture of an echinococcal cyst under ultrasound control in 1 patient. Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 4.3 days, after pericystectomy 19.8 1.4 days, after liver resection 14.4 2.7 days, after laparoscopic echinococcectomy 6, after percutaneous puncture echinococcal cyst 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy. Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.

Download Full-text

TREATMENT ADVANTAGES OF PATIENTS WITH URETEROLITHIASIS BY LITHOTRIPSY CONTACT METHODS IN COMPARISON WITH OPEN SURGERY

International Medical Journal ◽

10.37436/2308-5274-2019-4-9 ◽

2020 ◽

pp. 40-43

Author(s):

Bogdan-Boris Olegovich Biloruskyi

Keyword(s):

Open Surgery ◽

High Efficiency ◽

Average Duration ◽

Average Length ◽

Holmium Laser ◽

Ureteral Stricture ◽

Results Of Treatment ◽

Duration Of Surgery ◽

Endoscopic Methods ◽

Methods Of Treatment

One of the most effective methods of treatment of ureteral concretions is ureteroscopy with contact lithotripsy. The study analyzed the results of treatment of 96 patients with urolithiasis they were as follows: 44 patients underwent laser ureterolithotripsy, 52 persons had an open ureterolithotomy. When comparing different treatments for patients with ureterolithiasis, it has been found that the average duration of surgery when performing laser ureterolithotripsy was shorter and averaged 53 minutes. As for open ureterolithotomy it lasted in average 102 minutes. The average length of patients staying in clinic when performing laser ureterolithotripsy in average was 2.5 days, during open ureterolithotomy that index was 20 days. This is a significant advantage of endoscopic treatment of ureterolithiasis versus an open surgery (especially when a holmium laser is used in lithotripsy). By using endoscopic methods of treatment of ureteral concretions instead of an open surgery (ureterolithotomy), it has been possible to reduce the in−patient staying 8 times. Lithotripsy with a holmium laser occurred to be an effective method of destroying the ureteral concretions of any mineral composition, if the dimensions of these calculi did not exceed 2 cm. It should be emphasized that under these conditions, the localization of a stone and the duration of its stay in the ureter are also not important. In addition, the use of a holmium laser minimizes an injury to the ureter wall. The advantages of lithotripsy when it used with a holmium laser consist in its high efficiency in destruction of solid fixed and the ingrown stones. In case of combination of both a stone and ureteral stricture and in the presence of ligature calculi, the treatment with a holmium laser is also prescribed. Key words: ureterolithiasis, laser ureterolithotripsy, open ureterolithotomy, holmium laser.

Download Full-text

A Biomechanical Analysis of the Functions of the Deltoid during Abduction of the Arm

Engineering in Medicine ◽

10.1243/emed_jour_1982_011_003_02 ◽

1982 ◽

Vol 11 (1) ◽

pp. 3-10 ◽

Cited By ~ 3

Author(s):

P J M Scholten ◽

A de Boer ◽

W Vuisting

Keyword(s):

Biomechanical Analysis ◽

Muscle Fibres ◽

Centre Of Rotation

In this paper a method is presented for the analysis of the functions of the deltoid during abduction of the arm. The influence of several parameters such as the active and passive properties of the muscle, the length of the muscle fibres at certain positions of the arm, the kind of attachment of the deltoid to the scapula and the clavicula and the rotation of the scapula are discussed with respect to the behaviour of the muscle. The importance of the centre of rotation of the humerus in relation to the required equilibrium is shown.

Download Full-text