Acta Orthopaedica Belgica
Not a member yet
578 research outputs found
Sort by
Comparison of Isokinetic Muscle Strength and Clinical Outcome between Isolated and Combined PCL Reconstruction
No full textIntroduction: The purposes of this study were to 1) compare the functional result and muscle strength between patients who underwent reconstruction by isolated posterior cruciate ligament (PCL) and combined PCL-poseterolateral corner sling (PLCS) reconstruction.Materials and Methods:Nineteen (Group I: isolated PCL reconstruction) and 30 (Group II: combined PCL-PLCS reconstruction) were compared. The clinical results and isokinetic muscle strength were compared between groups.Results: The clinical results were comparable between groups and posterior stability was not different between the two groups, either. The isokinetic strength test result was not significantly different between the two groups, although absolute values of the flexion strength in Group I was higher than those in Group II. The HQ ratio of the affected side in Group I was similar to that of the contralateral side.Conclusions: Isokinetic muscle strength, especially flexion, was not fully recovered as compared with the contralateral side in both groups, although clinical and stability results were improved. However, the isolated PCL reconstruction group that was managed with the accelerated rehabilitation protocol showed an HQ ratio similar to that of the contralateral side. Therefore, an earlier active strengthening program would be also necessary in PCL-PLCS reconstructed groups, and justification for prevention of early weight bearing in PCL-PLCS reconstruction should be re-evaluated because weight bearing is helpful for muscle strengthening.
Title: Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty.
No full textBackground Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. HHS was compaired to the OHS assessing whether the HHS can be replaced by the OHS for clinical evaluation of THAs.Methods All 155 patients (167 THAs) were asked to complete an OHS before and one-year after surgery. The surgeon independently scored the HHS at the same time points. We examined and compared the clinimetric properties of both instruments.Results Internal consistency reliability of the OHS was notably higher than that of the HHS at all occasions. HHS had a higher effect size (4.1) than the OHS (2.1). Ceiling effect at follow up was 55.6% (HHS) and 36.4% (OHS). Spearman’s rank correlation between HHS and OHS was 0.57 at baseline and 0.65 and after one year. The correlation between the change scores was 0.50.Conclusion The Oxford Hip Score is of good use in quality assessment after THA
Small interprosthetic gaps do not increase femoral peri-prosthetic fracture risk. An in vitro biomechanical analysis.
No full textAbstractIt has been hypothesized that the interprosthetic gap between ipsilateral hip and knee replacements acts as a stress riser affecting bone fracture behaviour. The aim of this study was to quantify femoral strength and fracture morphology for a wide range of interprosthetic gaps.Seven interprosthetic gaps (0-20cm) were created in artificial femora (N=6-9/group). All specimens were loaded to failure following a compressive loading protocol. Fracture load and fracture morphology were recorded. Outcomes were compared to femora with a hip implant only (N=6; reference group).Fracture load was highest for 0 cm gaps. All other interprosthetic gaps had fracture loads similar to that of the reference group. Fracture occurred most frequently with a medial butterfly fragment located at the tip of the hip stem.We conclude that small gaps do not act as stress risers. The specific fracture morphology may benefit from different treatment than peri-prosthetic hip fractures
Fracture Management in Osteopetrosis: an Intrguing Enigma – a Guide for Surgeons
No full text Osteopetrosis is a disorder of diminished bone resorption with hard and brittle bones resulting in high rates of perioperative complications during an operative intervention. We present a series of 4 Subtrochanteric fractures treated surgically in 3 patients of Osteopetrosis in a tertiary level Orthopaedic centre over the last 3 years with an aim to highlight our preparation and technique, especially as a guide to other surgeons, to minimise the complication rates and optimise the results. The patients had a mean Harris Hip Score of 85, at a mean follow up of 21.5 months; the fractures united and all patients successfully returned to their normal activities of daily living
Multidisciplinary approach to osteosarcoma
No full textOsteosarcoma is a malignant bone tumor composed of mesenchymal cells producing osteoid and immature bone. Osteosarcoma is the most frequent primary malignant bone tumor, if we excluded myeloma, a haematologic disease.The incidence of osteosarcoma is 2–3/million/year, but is higher in adolescence, in which the annual incidence peaks at 8–11/million/year at 15–19 years of age.Local pain, followed by localized swelling and limitation of joint movement, are the typical signs and symptoms. Correct diagnosis can be achieved through a correct approach to the disease and the combination of clinical and radiographic aspects. The final step to confirm the diagnosis is the biopsy.Computer Tomography of the chest and Positron-Emission Tomography are mandatory to complete the staging, which is performed according the Musculoskeletal Tumor Society staging system.A multidisciplinary approach is needed both to get to a correct diagnosis (orthopaedic surgeon, radiologist and histopathologist) and to perform definitive treatment. Multidisciplinary approach should be performed in reference centers able to provide access to the full spectrum of care and where orthopaedic surgeon, oncologist, histopathologist, radiologist and radiotherapist can cooperate.
Primary total hip arthroplasty after acetabular fracture using intra-acetabular bended plates
No full textBackground. The surgical tactic for repair of common fracture patterns have been advanced. In the elderly, or in those cases in which there is significant destruction of the articular cartilage, primary total hip arthroplasty may provide the best solution.Materials and methods. The posterior Kocher-Langenbeck approach were used for exposure of the fracture. Excision of the femoral head provides for exposure of the anterior and posterior walls, the posterior column and superior acetabular area. Acetabular fracture reduction and stabilization of both columns using reconstructive plates and screws. After osteosynthesis of the acetabulum we used cemented total hip arthroplasty.Results. In our hospital 14 patients were treated by this technique with a followed-up after 4 - to 14 years. Excellent stability was achieved and the patient recovered excellent hip function results. Conclusions. Our proposed technique should be considered as an efficient technique that is well suited to elderly patients
Fascial flap surgery for recurrent dorsal ganglion.
No full textRecurrence after primary resection of a dorsal wrist ganglion may necessitate a reintervention. A technique was introduced in 2004 in which a flap of the extensor retinaculum is used to cover the defect left in the wrist capsule following repeat radical excision. This retrospective study presents the follow-up 4.6 years after this surgery in 20 patients. Recurrence, grip strength and possible flexion deficit are measured in 13 patients who attended clinic, as well as pain and satisfaction scores. Disability scores have been evaluated in 18 patients. One refractory patient was ascertained. A flexion deficit ≤ 10° was observed in 7 patients. Overall, mild pain, very mild disability, a flexion deficit of 14.2° and a loss of grip strength of 3.6 kg was observed. The retinaculum flap for recurrent dorsal wrist ganglion is a reliable procedure with limited risk for flexion deficit after surgery, high satisfaction rate and low recurrence risk
RISK FACTORS FOR ADDITIONAL SURGERY AFTER CLOSED REDUCTION OF HIP DEVELOPMENTAL DISLOCATION
No full textPurpose: to evaluate the risk factors for additional surgery after closed reduction of hip developmental dislocationMethods: closed reduction for developmental hip dislocation was performed on 72 patients, with a total of 82 hips. All were irreducible hip dislocation who treated by overhead traction followed by closed reduction under general anaesthesia and spica casting. The mean age at the time of closed reduction was 10 months, with 82% of dislocation diagnosed after 6 months. In 28 hips (34.1%), no additional surgical procedure was necessary, while 54 hips (65.9%) needed an additional surgery, consisting in Salter osteotomy in 40 hips (48.8%) or open hip reduction in 14 (17.1%).Results: risk factors for the need of additional surgery were: older age at the time of reduction, male sex, high grade of hip dislocation and quality of hip reduction. All the patients older than 17 months at the time of closed reduction needed additional surgery. Bilateral hip dislocation had poorer Severin grading than unilateral dislocation. Poorer Kalamchi scoring was associated with older age and with the presence of the cephalic nucleus at the time of reduction.Conclusion: this study confirmed delayed diagnosis of hip dislocation leads to a more extensive treatment with poorer issue.
A life-threatening situation due to a spider bite: A non-infectious necrotizing fasciitis.
No full text Introduction: we present the case of a healthy patient who sustained a spiderbite in the elbow and developed a non-infectious necrotizing fasciitis in the affected limbMaterial and Methods: Female patient aged 24 pain reported a spiderbite received some 72 h previously in Mexico (the spider was identified as a brown recluse spider--Loxosceles reclusa). Under the suspected diagnosis of necrotizing fasciitis urgent surgery was indicated.Results: During her hospital stay, the patient required three additional surgical procedures, and was discharged from hospital 30 days after admission.Conclusions: spider bites in the limb may be limb-threatening and life-threatening. Emergency doctors should be aware of this possibility, because spiders can be unintentionally transported all over the world
Positive impacts of Patient Blood Management in total hip arthroplasty. Retrospective and prospective studies (N=700)
No full textThe study aimed to determine the impact of implementing a patient blood management (PBM) policy during total hip arthroplasty. Firstly, the authors collected retrospective data concerning blood consumption for all patients (N= 577) having undergone total hip arthroplasty between 2009 and 2011, other than for post-traumatic indications. During this period, no coherent blood management rules were in place. Based on the results obtained, a blood transfusion strategy called Patient Blood Management (PBM) was defined and implemented in our department for this type of surgical procedure beginning 2012. The impact of PBM was then analyzed after a 6-month prospective study during 2013/2014 on a cohort of 123 patients. These prospective data demonstrate that PBM significantly improved patient care and reduced the need for allogeneic labile blood transfusions