SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Basics in hip chondrolabral lesions and state of the art
No full textChondrolabral complex is a weak point along an histological transition zone. Most cartilage and labral lesions in the femoroacetabular impingement syndrome are located in this area. Different classifications are used to evaluate the severity and predict the prognosis of chondrolabral complex injuries. Acetabular Labrum Articular Disruption (ALAD) and Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classifications are commonly used with a prognosis and treatment implication. Treatment of chondrolabral lesions detected on magnetic resonance imaging (MRI), should only be considered when clinical symptoms are presented. A wide range of treatment options include debridement with or without microfracture, repair or regenerate therapies. The future of hip joint preservation should be directed towards to the development of the treatment of chondrolabral injuries
Surgical hip dislocation in treatment of slipped capital femoral epiphysis
No full textBackground: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666–679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499–507].
Objective: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function.
Patients and methods: This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10–18 years). The mean follow-up period was 14.5 months (6–36 months).
Results: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip score (HHS) was (96.16 ± 9.7) and the mean improvement was (29.6 ± 9.6) (p = 0.0000).
Conclusions: The modified Dunn procedure allows to restore the normal proximal femoral anatomy by complete correction of the slip angle. This technique may reduce the probability of secondary osteoarthritis and femoroacetabular cam impingement
Management of soft-tissue sarcomas; treatment strategies, staging, and outcomes
No full textSoft-tissue sarcomas (STS) are a rare group of malignant tumors which can affect any age group. For the majority of patients who present with a localized STS, treatment involves a multidisciplinary team decision-making approach ultimately relying on surgical resection with or without adjuvant radiation for successful limb salvage. The goals of treatment are to provide the patient with a functional extremity without local tumor relapse. The purpose of this article is to review the treatment of extremity STS, with a focus on staging, treatment options, and outcomes
Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report
No full textIntroduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes.
Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit.
Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism.
Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary
Sudden peroneal nerve palsy in an osteoarthritic knee: a case report
No full textPeroneal nerve injuries have been reported in association with various causes around the knee such as traumatic varus injury, traumatic dislocation, upper tibial osteotomy, knee arthroscopy and total knee arthroplasty. Two instances of varus arthritic knee associated with a peroneal nerve palsy have been reported so far. One presented with gradual onset peroneal nerve palsy that recovered with time and the other with sudden onset peroneal nerve palsy that did not recover. We describe the case of a 63-year-old man who presented with a symptomatic varus arthritic knee and sudden onset peroneal nerve palsy with synovial cysts over the lateral aspect of the knee. We performed a total knee arthroplasty with decompression of the synovial cyst in the same patient. Three months following the surgery the patient was walking pain free with a completely recovered nerve palsy
Difference between biomarkers of tibial bone marrow and adipose tissue
No full textBackground: Stem cells, with their regeneration capacity, long-term viability, and differentiation characteristics, have indispensable biological properties. As described by Hauner and Grigoradis et al., mesenchymal stem cell originating from adipose or bone marrow can be differentiated into many tissues such as adipocyte, chondrocyte, myeloblast, and osteoblast. The aim of our study is to compare the use of adipose and tibial bone marrow derived stem cells for therapeutic purposes in orthopedic surgery, which has not been clearly evaluated in the literature to our knowledge and to also evaluate their use.
Material and method: Our study was performed between May 2014 and December 2016 in our clinic (Istanbul Medipol University, Department of Orthopedics and Traumatology) in 40 patients. Twelve patients were excluded. The ages of the 28 included patients ranged from 19 to 61 years, with a mean of 41.18 ± 13.39 years. The stem cell samples of these patients were analyzed by flow cytometry.
Results: Tibial bone marrow stem cells were used in 15 cases and the mean age was 49.33 ± 9.15. Adipose-derived stem cells were used in 13 patients and the mean age was 31.77 ± 11.25. None of the patients had any minor/major complication in the areas where stem cells were collected.
Discussion: Tibial-derived bone marrow has better results with regard to the complications, economic burden, and surgery time. Tibial-derived bone marrow harvesting and stem cell preparation time are one-fourth of the stem cell treatment prepared from adipose tissue and the surgical duration is shortened by 45 min.
Conclusion: If stem cell use is the preference of the surgeon, we have found that the tibial-derived stem cell system is more advantageous for ease of acquisition, cost analysis, and surgical time
Management of acetabular fractures in the geriatric patient
No full textIntroduction: Open reduction and internal fixation (ORIF) is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. Alarmingly, about 20–25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR.
Methods: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern.
Results: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures.
Discussion: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed
Arthroscopic autologous chondrocyte implantation in the hip for the treatment of full-thickness cartilage defects
No full textPurpose: Current literature indicates that the appropriate treatment of articular cartilage defects has significant influence on the postoperative outcome after hip arthroscopy. In the hip, arthroscopic treatment of cartilage defects is technically challenging, especially the autologous chondrocyte implantation/matrix-associated autologous chondrocyte implantation (ACI/MACI) procedures. The purpose of this prospective study was to introduce two injectable MACI products with self-adherent properties. Furthermore, we report short-term outcome and review the current literature.
Methods: Full-thickness cartilage defects of 29 patients caused by the femoroacetabular impingement (FAI) were treated arthroscopically with an injectable MACI product in a two-step surgical procedure. The patient-related outcome was assessed with International Hip Outcome Tool (iHOT33), Euro-Quol group score (EQ-5D) and Non-Arthritic-Hip-Score (NAHS) at baseline, six weeks, six, 12 and 24 months.
Results: Twenty-nine out of 46 patients (27 male/two female) with a mean age of 30.3 years (range 18–45 years) and an average defect size of 2.21 cm2 were available for follow-up after a mean of 19 months (range 6–24 months). All defects were located on the acetabulum International Cartilage Repair Society (ICRS) grade 3A–3D (nine 3A; eleven 3B; six 3C; three 3D). Twenty-six patients had associated labral pathology (23 repair 1–5 anchors; three partial trimming). Twenty-seven defects were caused by the FAI (20 CAM, six combined, one Pincer), two cases were of traumatic cause. An overall statistically significant improvement was observed for all assessment scores at an average follow-up of 19 months.
Conclusion: In this study, we present short-term data of new arthroscopic injectable matrix-associated, autologous chondrocyte implants as a treatment option for full-thickness cartilage defects of the hip. All patient-administered assessment scores demonstrated an increase in activity level, quality of life and reduction of pain after a 19-month follow-up. Further randomized controlled trails (RCTs) with comparison of natural history, bone marrow stimulation techniques and MACI of the hip have to approve the results in long-term follow-up
Lengthening and deformity correction about the knee using a magnetic internal lengthening nail
No full textIntroduction: The introduction of the internal lengthening nail (ILN) has changed the treatment of complex malalignment and shortening about the knee. Acute correction of the deformity and gradual lengthening through this osteotomy site has greatly simplified postoperative recovery. This manuscript is a review of the techniques that are currently being used in surgery.
Methods: The article is broken into two sections: distal femur osteotomy and tibia osteotomy. Each is addressed separately since they have different personalities. Also included are topics of particular interest that surface in ongoing conferences regarding the ILN. This work is a mix of expert opinion and best practice supported by peer reviewed publications on the topic.
Results: Most published series demonstrate excellent results with the ILN. Certain precautions are reiterated including avoiding mechanical failure, need for a percutaneous osteotomy, need for over-reaming, and the need for blocking screws.
Discussion: Current controversies will be brought to light and discussed. The reader should find this aspect particularly helpful in navigating this rapidly evolving field
A systematic review of the concept and clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics
No full textIntroduction: Mesenchymal stem cells (MSC’s) are believed to have multipotent plasticity with the capability to differentiate along multiple cell lineages such as cartilage, bone, tendon, muscle, and nerve. Such multipotency has the potential to play an important role in the repair and reconstruction of multiple tissues across a number of orthopaedic specialties. Bone marrow and fat are the most abundant and accessible source of MSC’s with bone marrow aspirate the most commonly being reported to stimulate healing.
Methods: This review examines the current reported 20 Q2 clinical applications of bone marrow aspirate concentrate and its effectiveness.
Results: The published studies reported techniques of collection and preparation of BMAC in addition to its applications in a number of orthopaedic sub-specialities. Studies could be sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (31), reconstruction of osseous defects/non-union (20), treatment of avascular necrosis (9), repair of cartilage defects (8), treatment of sports injuries and tendon injury/repair (9), injection in regenerative therapy (4), treatment of spine conditions (4) including enhancing postoperative fusion and degenerative disc pathology and orthopaedic oncology (4). A few published studies combined the use of platelet-rich plasma (PRP) with BMAC (4) or compared them in different applications (5).
Conclusions: BMAC has been used in bone, cartilage and tendon injuries with encouraging results