34 research outputs found
Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis
No full textPurpose: The purpose of this study was to evaluate the need for first metatarsophalangeal joint (MTPJ) arthrodesis as a measure of the Youngswick osteotomy survival, or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus.Methods: We retrospectively evaluated 61 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes in the long term using first metatarsophalangeal arthrodesis as an end point. The candidates for inclusion underwent clinical and radiographic evaluation, including the Foot and Ankle Outcome Score (FAOS).Results: Mean follow-up time was 54.8 months. All patients had improved their FAOS, with all achieving postoperative scores >75 points at the final follow up (P < 0.05). Although 49 % (P < 0.05) of the patients depicted worsening of the radiological aspect of the MTPJ, over the long time, no patient needed a first MTPJ arthrodesis.Conclusion: Our results show satisfying long-term outcomes with regard to function, pain relief, and patient satisfaction of the Youngswick osteotomy in grade II as well as grade III hallux rigidus that sustained over the follow up period; even in patients followed up for over 13 years. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved
Genetic polymorphism associated with the occurrence of postoperative nausea and vomiting (PONV) in patients undergoing oncological surgeries
No full textIntrodução: A decisão clínica sobre qual população cirúrgica deve receber medicação antiemética profilática é baseada preferencialmente em sistemas de pontuação com base no risco clínico. No entanto, os fatores herdados podem desempenhar um papel significativo na sensibilidade basal para NVPO em populações específicas. Métodos: Um estudo de casocontrole foi conduzido para identificar possíveis diferenças clínicas, étnicas e genéticas interindividuais que podem ser responsáveis por prever NVPO em uma população submetida a cirurgia oncológica. Foram seguidos consecutivamente 310 pacientes cirúrgicos durante as primeiras 24 horas de pós-operatório. Um buffy coat foi obtido a partir de 10 mL de amostra de sangue e processado para genotipagem de 32 diferentes polimorfismos de nucleotídeo único (SNPs), a partir de 23 genes candidatos, usando PCR em tempo real. Resultados: Sexo feminino, idade, história de NVPO/enjoo, uso de opioide pós-operatório, escore APFEL e vômito induzido por quimioterapia foram encontrados como fatores de risco para NVPO na análise univariada (p <0,05). História de NVPO ou cinetose permaneceu como o único fator preditor independente para NVPO na análise multivariada (OR ajustado = 3,15; IC 95%: 1,34-7,37, p = 0,008). Destaca-se associação significativa de rs208294 (gene P2RX7) e NVPO nos modelos de genótipo, dominante e alelo (p <0,05). Os modelos de regressão multivariada (ajustados para história de NVPO ou cinetose) mostraram o alelo C polimórfico de rs208294 como protetor contra NVPO. Além disso, foram encontradas associações significativas do polimorfismo rs17641121 (gene KCNJ3) e NVPO (p <0,05) em uma amostra estratificada classificada como escore de alto risco de acordo com o escore APFEL. As raças autodeclaradas e a ancestralidade molecular apresentaram maiores percentuais de componentes europeus, africanos ou asiáticos em pessoas autodeclaradas como brancas, negras ou amarelas, respectivamente. No entanto, não houve diferença na incidência de NVPO relacionada à raça. Conclusão: Antecedente de NVPO/cinetose, polimorfismo rs208294 do gene P2RX7 e polimorfismo rs17641121 do gene KCNJ3 são os preditores mais importantes para NVPO no presente estudoClinical decision on which surgical population should receive prophylactic anti-emetic medication is based preferentially on clinical risk-based score systems. However, inherited factors may play a significant role in background sensitivity for PONV in specific populations. Methods: A case-control study was conducted to identify possible clinical, ethnic and genetic inter-individual differences that may account for PONV prediction in a population undergoing cancer surgery. We consecutively followed 310 surgical patients during the first 24 postoperative hours. A buffy coat was obtained from a 10 mL blood sample and processed for genotyping of 32 different single nucleotide polymorphisms (SNPs), from 23 candidate genes, using Real-time PCR. Results: Female gender, age, history of PONV/motion sickness, postoperative opioid use, APFEL score and chemotherapy-induced vomiting were found as risk factors for PONV in univariate analysis (p<0.05). History of PONV or motion sickness remained as the only independent predictor factor for PONV in the multivariate analysis (adjusted OR=3.15; 95% CI: 1.34-7.37, p=0.008). We detected significant association of rs208294 (P2RX7 gene) and PONV in Genotype, Dominant and Allele Models (p<0.05). The multivariate regression models (adjusted for history of PONV or motion sickness) showed the polymorphic C allele of rs208294 as protector against PONV. Furthermore, we found significant associations of rs17641121 polymorphism (KCNJ3 gene) and PONV (p<0.05) in a stratified sample classified as high-risk score according to APFEL Score. Self-declared races and molecular ancestry showed higher percentages of European, African or Asian components in people self-reported as White, Black or Yellow, respectively. However, there was no difference in the incidence of PONV related to race. Conclusion: Previous PONV/motion sickness, rs208294 polymorphism from P2RX7 gene and rs17641121 polymorphism from KCNJ3 gene are the most important predictors for PONV in the present stud
TV-018. DOSIS ÚNICA DE TRANEXÁMICO EN EL REEMPLAZO TOTAL DE CADERA: TRANSFUSIONES, EFECTOS ADVERSOS Y MORBIMORTALIDAD
No full textIntroducción: Un gran número de reportes han probado la eficacia y seguridad del ácido tranexámico (TXA) en reducir la pérdida sanguínea en prótesis total de cadera (PTC). Sin embargo, muchos de estos estudios han analizado la acción del TXA con dosificaciones variadas, distintos tiempos de administración, distintos tipos de PTC y diversos tipos de anestesia. Objetivos: Estudiar los efectos de una dosis única de 1g preoperatorio de TXA, en la tasa de transfusión, sus efectos adversos, estadía hospitalaria y readmisión en pacientes sometidos a PTC electiva utilizando anestesia espinal. Material y métodos: Efectuamos un estudio retrospectivo entre enero 2012 y enero 2014 de 172 pacientes consecutivos sometidos a PTC primaria electiva. Se incluyeron sólo pacientes operados por el mismo cirujano y mismo anestesiólogo. Se excluyeron pacientes con discrasias sanguíneas, tratamiento antitrombótico, historia de insuficiencia hepática o renal, epilepsia y enfermedad tromboembólica (ETE). Se utilizaron los protocolos de transfusión del Servicio de Hematología de la institución. El momento de la transfusión fue categorizado en 2 grupos: durante la cirugía y durante el resto de la estadía hospitalaria. Las variables primarias fueron el número de transfusiones de glóbulos rojos (TGR) y la influencia en los distintos tipos PTC de acuerdo al tipo de fijación femoral. Las variables secundarias involucraron: hematocrito de alta, tiempo de estadía hospitalaria, ETE, convulsiones, readmisiones dentro de los 3 meses postoperatorios y mortalidad. Resultados: La TGR promedio fue de 1,53 unidades/paciente en el grupo control y 0,6 unidades/paciente en el grupo TXA (z = 6,29; U = 1.640,5, p < 0,0001). El uso del TXA presentó una correlación significativa con la TGR (p < 0,0001, IC95%: -1,24 y -0,68). El riesgo relativo de reducción de la TGR se observó tanto durante la cirugía (OR: 0,14; IC 0,06-0,29; p < 0,0001) como en el resto de la estadía hospitalaria (OR: 0,11; IC 0,01-0,96; p = 0,046). Ambos tipos de PTC que recibieron TXA, si bien no presentaron diferencias significativas entre ellas (p = 0,13), fueron transfundidos menos que sus respectivos controles (0,57 ± 1 vs 1,7 ± 1, p < 0,01 y 0,65 ± 1 vs 1,2 4 ± 1, p < 0,01). No se hallaron diferencias con respecto a hematocrito al momento del alta, el tiempo de estadía hospitalaria y efectos adversos. Seis pacientes del grupo control fueron reinternados mientras que 3 lo hicieron en el grupo TXA (p = N/S). Ningún paciente falleció durante el seguimiento. Conclusiones: Una dosis única preoperatoria de TXA redujo la tasa de TGR sin aumentar la incidencia de efectos adversos, estadía hospitalaria, readmisiones hospitalarias ni mortalidad, tanto para prótesis híbridas como no cementadas
How Reliable is Clinical Evaluation in Hindfoot Coronal Alignment?
No full textCategory: Hindfoot Introduction/Purpose: Hindfoot alignment in the coronal plane is an extremely important aspect to consider in order to make a comprehensive evaluation of different foot and ankle disorders. To the authors knowledge the evidence concerning the precision of clinical hindfoot alignment assessment is scarce. The aim of this study is to evaluate correlation and reproducibility between clinical and radiographical hindfoot alignment. Methods: Intra and interobserver reliability of clinical and radiographical hindfoot assessment was performed in 85 patients. Clinical alignment was evaluated on photographs taken at the time of presentation and hindfoot alignment was quantified on long axial view radiographs in neutral rotation position. Photographs were classified into three categories (valgus, neutral and varus) and radiographs were measured taking standardized parameters. Each observer made measurements independently and was blinded to both patient identification and the others’ measurements. All measurements were made on two separate occasions with the order of images randomized. Results: We did not observe a significant correlation between clinical and radiographical assessment (k1a 0,072 - p=0,24; k1b 0,167 - p=0,029; k2a 0,23 - p< 0,001; k2b 0,137 - p=0,021). We did find a good clinical and radiographical intraobserver agreement (K1= 0,789; K2=0,783; Pearson1= 0,956; Pearson2= 0,990). Clinical interobserver agreement was moderate (K1= 0,584; K2=0,566) while radiographical interobserver agreement was statical significant (Pearson1= 0,926; Pearson2= 0,953). Conclusion: Due to a poor clinical-radiographical correlation we should not rely on clinical evaluation to guide the decision making in different foot and ankle conditions. We strongly recommend the use of the long axial view in order to assess the magnitude of the hindfoot deformity
Abordaje del seno del tarso para el tratamiento de las fracturas de calcáneo: una técnica de creciente difusión
No full textObjetivo: Describir los resultados radiográficos y funcionales, y las complicaciones de la osteosíntesis de fracturas de calcáneo mediante el abordaje del seno del tarso.
Materiales y Métodos: Se evaluaron 54 fracturas articulares de calcáneo desplazadas en 50 pacientes con radiografías de pie, de frente y de perfil, y tomografía computarizada preoperatorias. Se tomaron radiografías de pie, de frente y de perfil sin carga en el posoperatorio inmediato y con carga a las semanas 6 y 12, y al final del seguimiento. Se midió el ángulo de Böhler y se cuantificó el grado de artrosis subastragalina y calcaneocuboidea. Se determinó el puntaje de la AOFAS y se registraron las complicaciones de la herida, las lesiones neurológicas y la necesidad de cirugías adicionales, como retiro del material de osteosíntesis y artrodesis subastragalina.
Resultados: El seguimiento fue de 30.8 meses. La serie estaba formada por 8 mujeres y 42 hombres, con una edad de 39.40 ± 14 años (rango 18-65). Cuarenta fracturas eran Sanders tipo II, 13 tipo III y 1 tipo IV. El puntaje de la AOFAS fue: excelente (12 casos), bueno (25 casos), regular (12 casos) y malo (5 casos). El ángulo de Böhler preoperatorio era de 10,8 ± 10,4° y 30,77 ± 8,24° al final del seguimiento (p <0,00001). El 3,7% tuvo complicaciones menores de la herida y el 5,6%, complicaciones mayores.
Conclusión: El abordaje del seno del tarso permite una reducción aceptable con resultados buenos y excelentes en la mayoría de los pacientes y escasas complicaciones de partes blandas
Tratamiento de las fracturas femorales periprotésicas Vancouver B3 con injerto óseo impactado. Supervivencia y complicaciones
No full textObjetivos: El tratamiento de elección para las fracturas femorales periprotésicas Vancouver B3 aún no está definido. Por este motivo, nos propusimos analizar la tasa de complicaciones de la técnica de injerto óseo impactado con un vástago cementado cuando se utiliza para tratar estas fracturas.
Materiales y Métodos: Estudiamos retrospectivamente 33 fracturas femorales periprotésicas B3 tratadas con la técnica de injerto óseo impactado operados entre 2000 y 2016, analizando la tasa de complicaciones. La mediana de seguimiento fue de 75 meses (RIC 36-111). La mediana de edad fue de 78 años (RIC 74-83). La mediana del defecto óseo femoral fue 3 (RIC 3-3) según la clasificación de la Endo-Klinik. Se realizó un análisis de regresión múltiple para determinar los factores de riesgo asociados a complicaciones, las variables incluidas fueron: cantidad de cirugías previas, diámetro de la nueva cabeza femoral y defecto óseo femoral.
Resultados: Se realizó una cirugía de revisión en dos etapas en cuatro pacientes. Se registraron cinco fallas asépticas del implante y dos luxaciones en toda la serie. El análisis de regresión lineal multivariable mostró una asociación significativa entre el grado del defecto óseo femoral Endo-Klinik y la tasa de complicaciones
(p = 0,04).
Conclusión: La reconstrucción femoral con la técnica de injerto óseo impactado para tratar fracturas periprotésicas Vancouver B3 provocó una alta tasa de complicaciones
Metaphyseal debonding of the Corail collarless cementless stem
No full textAims The Corail stem has good long-term results. After four years of using this stem, we have detected a small group of patients who have presented with symptomatic metaphyseal debonding. The aim of this study was to quantify the incidence of this complication, to delineate the characteristics of patients presenting with this complication and to compare these patients with asymptomatic controls to determine any important predisposing factors. Patients and Methods Of 855 Corail collarless cementless stems implanted for osteoarthritis, 18 presented with symptomatic metaphyseal debonding. A control group of 74 randomly selected patients was assembled. Clinical and radiological parameters were measured and a logistic regression model was created to evaluate factors associated with metaphyseal debonding. Results The prevalence of this complication was 2.1% in our series. In the multivariable model, the presence of a Dorr B-type proximal femur was associated with metaphyseal debonding (odds ratio (OR) 10.73, 95% confidence interval (CI) 2.31 to 49.97, p = 0.002), as was a body mass index > 25 kg/m2 (OR 6.85, 95% CI 1.06 to 44.28, p = 0.04). Smaller stems and the use of a polyethylene acetabular liner appeared to be protective when compared with metal and ceramic setting hard-on-hard bearings. Conclusion We have described an uncommon but important mode of failure of the Corail stem. Surgeons should be aware of this phenomenon; overweight patients with Dorr B-type femurs and in whom hard bearings are used appear to be particularly at risk. Cite this article: Bone Joint J 2017;99-B:1435–41. </jats:sec
Olanzapine as an add‐on, pre‐operative anti‐emetic drug for postoperative nausea or vomiting: a randomised controlled trial
No full textPostoperative nausea or vomiting occurs in up to 40% in patients with multiple risk factors, despite prophylaxis. Olanzapine is an antipsychotic drug that is used to prevent nausea and vomiting in palliative care and to treat chemotherapy-induced nausea and vomiting. This study aimed to examine whether pre-operative olanzapine, as a prophylactic anti-emetic added to intra-operative dexamethasone, ondansetron and total intravenous anaesthesia, reduced the incidence of postoperative nausea or vomiting. We performed a multiply-blinded randomised controlled trial in patients aged 18-60 years with cancer at high risk of postoperative nausea or vomiting (three or four risk factors according to the Apfel criteria) plus a previous history of chemotherapy-induced nausea and vomiting. Patients were allocated at random to receive 10 mg olanzapine or placebo orally 1 h before surgery in addition to a two-drug regimen (dexamethasone and ondansetron) and propofol anaesthesia to prevent postoperative nausea or vomiting. The primary outcome was the incidence of postoperative nausea or vomiting in the first 24 h after surgery. In total, 100 patients were enrolled; 47 in the olanzapine group and 49 in the control group completed the study. The baseline characteristics of the groups were similar. The incidence of postoperative nausea or vomiting in the first 24 h after surgery was lower in the olanzapine group (12/47, 26%) than in the control group (31/49, 63%) (p = 0.008, RR 0.40 (95%CI 0.21-0.79)). Adding pre-operative oral olanzapine to intra-operative dexamethasone and ondansetron was highly effective in reducing the risk of postoperative nausea or vomiting in the first 24 hours after surgery in patients with a previous history of chemotherapy-induced nausea and vomiting and at least three Apfel risk factors for postoperative nausea or vomiting.</p
Flexor Digitorum Longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: A clinical and radiographical analysis
No full textInfluence of femoral component design on proximal femoral bone mass after total hip replacement : a randomized controlled trial
No full textBackground:
In this randomized controlled trial (RCT), we compared bone remodeling and bone turnover between 2 total hip arthroplasty implants—the short, proximally porous-coated Tri-Lock Bone-Preservation Stem and a conventional, fully-coated Corail prosthesis—over a 2-year postoperative period.
Methods:
Forty-six participants received the Tri-Lock prosthesis and 40 received the Corail prosthesis. At baseline, the 2 groups had similar demographics, proximal femoral bone mineral density (BMD), bone turnover markers, radiographic canal flare index, and patient-reported outcome measure (PROM) scores. Outcomes were measured at weeks 26, 52, and 104.
Results:
Loss of periprosthetic bone, measured by high-sensitivity dual x-ray absorptiometry region-free analysis (DXA-RFA), was identified at the calcar and proximal-lateral aspect of the femur in both prosthesis groups (p 0.05). The adverse-event rate was also similar between the groups (p > 0.05).
Conclusions:
This RCT shows that prostheses intended to preserve proximal femoral bone do not necessarily perform better in this regard than conventional cementless designs. DXA-RFA is a sensitive tool for detecting spatially complex patterns of periprosthetic bone remodeling.
Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
