Detection of metal ions in hair after metal–metal hip arthroplasty
Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal
D. Hernandez-Vaquero, M. Rodríguez de la Flor, J.M. Fernandez-Carreira, C. Sariego-Muñiz
Rev Esp Cir Ortop Traumatol. 2014;58(5):267-273
Abstract
Objective
There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal–metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant.
Materials and methods
The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal–polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst.
Results
The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis.
Conclusions
High concentrations of metals in the hair are observed in hip replacements with metal–metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models.
Nivel de evidencia 3
01 octubre 2014
Hombro/Shoulder/Schülter/Épaule: parálisis en la silla de playa
Lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position: a report of 4 cases.
Satin AM, DePalma AA, Cuellar J, Gruson KI1.
Am J Orthop (Belle Mead NJ). 2014 Sep;43(9)
Abstract
Neuropathy of the lateral femoral cutaneous nerve can present as pain, decreased sensation, and/or burning or tingling on the anterolateral thigh. We present 4 cases of lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position, all of which occurred in obese patients. This complication, to our knowledge, has never been reported in conjunction with the beach chair position. We believe that the neurapraxia was due to external compression by the patients' abdominal pannus. Full resolution of symptoms can be expected within 6 months following conservative management. A preoperative discussion regarding this complication should occur with obese patients undergoing shoulder surgery in the beach chair position.
Satin AM, DePalma AA, Cuellar J, Gruson KI1.
Am J Orthop (Belle Mead NJ). 2014 Sep;43(9)
Abstract
Neuropathy of the lateral femoral cutaneous nerve can present as pain, decreased sensation, and/or burning or tingling on the anterolateral thigh. We present 4 cases of lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position, all of which occurred in obese patients. This complication, to our knowledge, has never been reported in conjunction with the beach chair position. We believe that the neurapraxia was due to external compression by the patients' abdominal pannus. Full resolution of symptoms can be expected within 6 months following conservative management. A preoperative discussion regarding this complication should occur with obese patients undergoing shoulder surgery in the beach chair position.
30 septiembre 2014
Rodilla/Knee/Knie/Genou: más sencillo poner una prótesis meniscal
Releasing the circumferential fixation of the medial meniscus does not affect its kinematic
A.C.T. Vrancken , T.G. van Tienen , G. Hannink , D. Janssen , N. Verdonschot , P. Buma
The Knee: Publication date: Available online 26 September 2014
Background
Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern.
Methods
Human cadaveric knee joints were flexed (0°–30°–60°–90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured.
Results
Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered.
Conclusions
This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament.
Clinical relevance
The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation.
A.C.T. Vrancken , T.G. van Tienen , G. Hannink , D. Janssen , N. Verdonschot , P. Buma
The Knee: Publication date: Available online 26 September 2014
Background
Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern.
Methods
Human cadaveric knee joints were flexed (0°–30°–60°–90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured.
Results
Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered.
Conclusions
This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament.
Clinical relevance
The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation.
29 septiembre 2014
Rodilla/Knee/Knie/Genou: 30 años después de la PTR
Total Knee Replacement in Young, Active Patients: Long-Term Follow-up and Functional Outcome: A Concise Follow-up of a Previous Report
Long, W. J., Bryce, C. D., Hollenbeak, C. S., Benner, R. W., Scott, W. N.
The Journal of Bone & Joint Surgery, 17 Septiembre 2014 19:30
Abstract:
Concern exists regarding the long-term durability and effectiveness of total knee arthroplasty in young patients.
We reviewed our experience with total knee arthroplasty in patients fifty-five years old and younger with severe osteoarthritis to determine the long-term outcomes. One hundred and fourteen total knee arthroplasties were performed in eighty-eight patients at an average patient age of fifty-one years. Clinical outcomes, survival analysis, and radiographs were all reviewed at the most recent follow-up. One hundred and eight knees (eighty-four patients) were followed up from May 2011 to 2012.
At thirty years, survivorship without revision for any cause was 70.1% (twenty-five revisions) and survivorship with failure defined as aseptic revision of the tibial or femoral components was 82.5%. At thirty years, a significant difference existed in the survivorship free from tibial or femoral aseptic revision (p = 0.003) between the non-modular Insall-Burstein I component (92.3%) and the modular Insall-Burstein II component (68.3%). All patients were evaluated at an average time from the index total knee arthroplasty to the latest follow-up of 25.1 years (range, twenty to thirty-five years). Clinical evaluation was obtained in thirty-six patients with forty-five total knee arthroplasties. The average Hospital for Special Surgery score had improved from 57.9 points preoperatively to 85.3 points. The average Knee Society score was 87.4 points and the average Knee Society functional score was 62.1 points; the average knee motion was 110°. The mean Tegner and Lysholm activity score improved from 1.5 points preoperatively to 3.0 points. Radiographic review of forty-two knees that had undergone total knee arthroplasty demonstrated a mean 3.2° of valgus, with no cases of radiographically loose components.
Total knee arthroplasty with use of a cemented posterior stabilized system, particularly a non-modular Insall-Burstein I design, was an effective treatment option with durable results for end-stage symptomatic osteoarthritis in this young cohort. These data should provide comparison for modern total knee arthroplasties and alternative procedures in young patients.
Level of Evidence:
Therapeutic Level IV
Long, W. J., Bryce, C. D., Hollenbeak, C. S., Benner, R. W., Scott, W. N.
The Journal of Bone & Joint Surgery, 17 Septiembre 2014 19:30
Abstract:
Concern exists regarding the long-term durability and effectiveness of total knee arthroplasty in young patients.
We reviewed our experience with total knee arthroplasty in patients fifty-five years old and younger with severe osteoarthritis to determine the long-term outcomes. One hundred and fourteen total knee arthroplasties were performed in eighty-eight patients at an average patient age of fifty-one years. Clinical outcomes, survival analysis, and radiographs were all reviewed at the most recent follow-up. One hundred and eight knees (eighty-four patients) were followed up from May 2011 to 2012.
At thirty years, survivorship without revision for any cause was 70.1% (twenty-five revisions) and survivorship with failure defined as aseptic revision of the tibial or femoral components was 82.5%. At thirty years, a significant difference existed in the survivorship free from tibial or femoral aseptic revision (p = 0.003) between the non-modular Insall-Burstein I component (92.3%) and the modular Insall-Burstein II component (68.3%). All patients were evaluated at an average time from the index total knee arthroplasty to the latest follow-up of 25.1 years (range, twenty to thirty-five years). Clinical evaluation was obtained in thirty-six patients with forty-five total knee arthroplasties. The average Hospital for Special Surgery score had improved from 57.9 points preoperatively to 85.3 points. The average Knee Society score was 87.4 points and the average Knee Society functional score was 62.1 points; the average knee motion was 110°. The mean Tegner and Lysholm activity score improved from 1.5 points preoperatively to 3.0 points. Radiographic review of forty-two knees that had undergone total knee arthroplasty demonstrated a mean 3.2° of valgus, with no cases of radiographically loose components.
Total knee arthroplasty with use of a cemented posterior stabilized system, particularly a non-modular Insall-Burstein I design, was an effective treatment option with durable results for end-stage symptomatic osteoarthritis in this young cohort. These data should provide comparison for modern total knee arthroplasties and alternative procedures in young patients.
Level of Evidence:
Therapeutic Level IV
Codo/Elbow/Ellbogen/Coude: Epicondilitis para perder los nervios
Epicondylitis and denervation surgery
Rose, Nicholas E.a; Dellon, A. Leeb
Current Orthopaedic Practice:
September/October 2014 - Volume 25 - Issue 5 - p 446-452
Abstract
Lateral and medial epicondylitis are two of the most common musculoskeletal conditions affecting the upper extremity. Yet, their exact etiology and optimal treatment remain controversial. Even the efficacy of traditional nonoperative treatments, such as physical therapy and corticosteroid injections, is disputed, with many studies failing to demonstrate long-term benefits with either modality. Newer treatments, such as extracorporeal shock wave therapy and platelet rich plasma, show promise. However, despite the theoretic advantages of these treatments, clinical results remain mixed. When nonoperative treatments fail, traditional surgery in the form of a medial or lateral release remains the mainstay of treatment. However, recovery times from these open release procedures remain prolonged. Recent clinical trials evaluating medial and lateral elbow denervation surgery show that these less invasive techniques may bring permanent resolution to this difficult problem with less pain and shorter recovery times.
Rose, Nicholas E.a; Dellon, A. Leeb
Current Orthopaedic Practice:
September/October 2014 - Volume 25 - Issue 5 - p 446-452
Abstract
Lateral and medial epicondylitis are two of the most common musculoskeletal conditions affecting the upper extremity. Yet, their exact etiology and optimal treatment remain controversial. Even the efficacy of traditional nonoperative treatments, such as physical therapy and corticosteroid injections, is disputed, with many studies failing to demonstrate long-term benefits with either modality. Newer treatments, such as extracorporeal shock wave therapy and platelet rich plasma, show promise. However, despite the theoretic advantages of these treatments, clinical results remain mixed. When nonoperative treatments fail, traditional surgery in the form of a medial or lateral release remains the mainstay of treatment. However, recovery times from these open release procedures remain prolonged. Recent clinical trials evaluating medial and lateral elbow denervation surgery show that these less invasive techniques may bring permanent resolution to this difficult problem with less pain and shorter recovery times.
28 septiembre 2014
Cadera/Hip/Hüfte/Hanche: Tratar el choque femoroacetabular en pacientes muy jóvenes
Femoroacetabular Impingement in Skeletally Immature Patients: A Systematic Review Examining Indications, Outcomes, and Complications of Open and Arthroscopic Treatment
Author(s): Darren de SA , Stephanie Cargnelli , Michael Catapano , Asheesh Bedi , Nicole Simunovic , Sarah Burrow , Olufemi R. Ayeni
Source:Arthroscopy: The Journal of Arthroscopic & Related Surgery. Publication date: Available online 26 September 2014
Purpose
Improvements in physical examination and radiographic appreciation of symptomatic femoroacetabular impingement (FAI) has increased the focus on early diagnosis and treatment in an adolescent population. This systematic review aimed to establish specific indications, outcomes, and complications of surgical management of adolescent FAI.
Methods
The Medline, Embase, and PubMed online databases were searched from inception until April 21, 2014, for English-language studies that addressed open and/or arthroscopic treatment of FAI in patients aged 10 to 19 years inclusively. The studies were systematically screened and data abstracted in duplicate, with qualitative findings presented.
Results
There were 6 eligible case series (4 with arthroscopic and 2 with open technique) and 2 conference abstracts examining 388 patients in total (435 hips), 81% of which were treated with hip arthroscopy. Overall, patients were followed up for a mean of 23.4 months postoperatively (range, 3 to 75 months). The main indication for surgery was a confirmed diagnosis of FAI with persistent pain and impaired function refractory to nonoperative interventions (activity modification, intra-articular injections, and so on). Specific contraindications included Tönnis grade 2, 3, or 4 chondral changes and acetabular dysplasia. All studies reported significant improvements in patient pain, function (e.g., no patients were “abnormally” or “severely abnormally” impaired), and satisfaction rates (84% to 100% with arthroscopic technique v 79% with open technique). Improvements also were observed in range of motion and alpha angle correction, as well as across a variety of patient-reported functional scores, with all but 7 of 388 patients (1.8%) returning to activity/sport. No major complications were reported, with only 13 of 354 hips (3.7%) treated by arthroscopy requiring revision arthroscopy for lysis of adhesions and 1 of 81 open surgical dislocation hips (1%) having asymptomatic heterotopic ossification not requiring additional management. No cases of avascular necrosis, physeal arrest or growth disturbance, or iatrogenic deformity were reported.
Conclusions
Both arthroscopic and open surgical dislocation approaches for the treatment of adolescent FAI appear to be safe and effective options for patients with persistent pain and limited function after an appropriate trial of nonoperative therapy.
Level of Evidence
Level IV, systematic review of Level IV studies.
Trauma: Más atrás de lo que parece
An anatomical study of the entry point in the greater trochanter for intramedullary nailing
Farhang, K., Desai, R., Wilber, J. H., Cooperman, D. R., Liu, R. W.
Bone Joint J 2014;96-B:1274–81.
Malpositioning of the trochanteric entry point during the introduction of an intramedullary nail may cause iatrogenic fracture or malreduction. Although the optimal point of insertion in the coronal plane has been well described, positioning in the sagittal plane is poorly defined.
The paired femora from 374 cadavers were placed both in the anatomical position and in internal rotation to neutralise femoral anteversion. A marker was placed at the apparent apex of the greater trochanter, and the lateral and anterior offsets from the axis of the femoral shaft were measured on anteroposterior and lateral photographs. Greater trochanteric morphology and trochanteric overhang were graded.
The mean anterior offset of the apex of the trochanter relative to the axis of the femoral shaft was 5.1 mm (sd 4.0) and 4.6 mm (sd 4.2) for the anatomical and neutralised positions, respectively. The mean lateral offset of the apex was 7.1 mm (sd 4.6) and 6.4 mm (sd 4.6), respectively.
Placement of the entry position at the apex of the greater trochanter in the anteroposterior view does not reliably centre an intramedullary nail in the sagittal plane. Based on our findings, the site of insertion should be about 5 mm posterior to the apex of the trochanter to allow for its anterior offset.
Farhang, K., Desai, R., Wilber, J. H., Cooperman, D. R., Liu, R. W.
Bone Joint J 2014;96-B:1274–81.
Malpositioning of the trochanteric entry point during the introduction of an intramedullary nail may cause iatrogenic fracture or malreduction. Although the optimal point of insertion in the coronal plane has been well described, positioning in the sagittal plane is poorly defined.
The paired femora from 374 cadavers were placed both in the anatomical position and in internal rotation to neutralise femoral anteversion. A marker was placed at the apparent apex of the greater trochanter, and the lateral and anterior offsets from the axis of the femoral shaft were measured on anteroposterior and lateral photographs. Greater trochanteric morphology and trochanteric overhang were graded.
The mean anterior offset of the apex of the trochanter relative to the axis of the femoral shaft was 5.1 mm (sd 4.0) and 4.6 mm (sd 4.2) for the anatomical and neutralised positions, respectively. The mean lateral offset of the apex was 7.1 mm (sd 4.6) and 6.4 mm (sd 4.6), respectively.
Placement of the entry position at the apex of the greater trochanter in the anteroposterior view does not reliably centre an intramedullary nail in the sagittal plane. Based on our findings, the site of insertion should be about 5 mm posterior to the apex of the trochanter to allow for its anterior offset.
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