Abstract. Introduction.
Introduction. Osteonecrosis of the knee encompasses three conditions; spontaneous osteonecrosis of the knee,
Purpose: We hypothesized that thrombophilia-hypofibrinolysis are risk factors for femoral head osteonecrosis. Separately, we hypothesized that when Enoxaparin is started at Ficat stages I or II in patients with idiopathic osteonecrosis and thrombophilia-hypofibrinolysis, progression of osteonecrosis can be stopped. Method: We compared measures of thrombophilia and hypofibrinolysis in 71 adults with idiopathic osteonecrosis, in 62 with corticosteroid-associated
Background.
The purpose of our study was to identify possible risk factors of patients with GCT of the long bones after curettage and packing the bone cavity with bone cement or bone allografts. We retrospectively reviewed the records of 249 patients with GCT of the limbs treated at Musculoskeletal Oncology Department of our institution between 1990 and 2013, confirmed histologically and recorded in the Bone Tumor Registry. We reviewed 219 cases located in the lower limb and 30 of the upper limb. This series includes 135 females and 114 males, with mean age 32 years (ranging 5 to 80 yrs). According to Campanacci's grading system, 190 cases were stage 2, 48 cases stage 3, and 11 cases stage 1. Treatment was curettage (intralesional surgery). Local adjuvants, such as phenol and cement, were used in 185 cases; whereas in the remaining 64 cases the residual cavity was filled with allografts or autografts only. Oncological outcome shows 203 patients alive and continuously disease-free (CDF), 41 patients NED1 after treatment of local recurrence (LR), 2 patients NED1 after treatment of lung metastases, 2 AWD with lung metastases. One patient died of unrelated causes (DOD). LR rate was 15.3% (38 pts). Lung metastases rate was 1.6% (4 pts). In patients treated by curettage and cement (185 cases) LR was 12% (22 pts). Conversely, in patients treated curettage and bone allografts it was higher (16/64 cases), with an incidence of 25% of cases (p=0.004). Oncological complications seemed to be related with site, more frequently occurring in the proximal femur (p=0.037). LR occurred only in stage 2 or 3 tumors without statistical significance (p>0.05). The mean interval between the first surgical treatment and LR was 22 months (range: 3–89 mos). However, in the multivariate analysis no significant statistical effect on local recurrence rate could be identified for gender, patient's age, Campanacci's grading, or cement vs allografts. The only independent risk factor related to the local recurrence was the site, with a statistical significance higher risk for patients with GCT of the proximal femur (p= 0.008). Our observation on the correlation of tumor location and risk of local recurrence is new. Therefore, special attention must be given to GCTs in the proximal femur. In fact, primary benign bone tumors in the proximal femur are difficult to treat due to the risk of
INTRODUCTION. The literature suggests a survivorship of unicompartmental knee arthroplasties (UKA) for spontaneous osteonecrosisof the knee range from 93% to 96.7% at 10 to 12 years. However, these data arise from series reporting 23 to 33 patients, jeopardizing meaningful conclusions. OBJECTIVES. Our purpose is to examine a long term survivorship of UKA's in a larger group of patients with SPONK, along with their subjective, symptomatic and functional outcome; to determine the percentage of failures and the reasons for the same in an attempt to identify relevant indications, contraindications, and technical parameters in treating SPONK with a modern implant design. METHODS. We retrospectively evaluated 84 patients with late-stage spontaneous osteonecrosis of the knee who had a medial UKA from 1998 to 2005. All patients had preoperative MRI to confirm the diagnosis, exclude metaphyseal involvemente, and confirm the absence of major degenerative changes in the lateral and patellofermoal compartment. Mean age at surgery was 66 years and mean body mass index was 28.9. A Kaplan-Meier survival analysis was conducted using revision for any reason as the end point. The minimum followup of 63 months (mean, 98 months; range, 63–145 months). RESULTS. The 10-year survivorship was 92%. Ten revisons were performed and the most common reasons for revision were subsidence of the tibial component (four) and aseptic loosening of the tibial component (three). No patient underwent revision for osteoarthritis progression in the lateral or patellofemoral compartment. There was a statistically significant difference between postoperative VAS, KSS, WOMAC, Oxford, Range of Motion and Tibial Slope (overcorrected by 3.7 degrees, p< 0.0023) between the survivors and the failures. CONCLUSION. SPONK may be an optimal indication for UKA provided
Purpose: Spontaneous osteonecrosis of the knee is a potentially greatly debilitating condition. While success has been reported with non-operative treatment of this disorder in its earliest stages, knee arthroplasty is the only viable modality if allowed to progress to condylar collapse. The purpose of this report is to review the etiologic and pathophysiologic principles of spontaneous osteonecrosis of the knee, to present our experience with joint-preserving surgical treatment of this condition, and finally to introduce a treatment algorithm developed based on this knowledge. Method: Seventeen patients with a clinical and/or radiographic a diagnosis of spontaneous osteonecrosis of the knee, and exclusion of
The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis
Treatment of chronic osteomyelitis (COM) for young patients remains a challenge. Large bone deficiencies secondary to COM can be treated using induced membrane technique (IMT). However, it is unclear which type of bone graft is optimal. The goal of the study was to determine the clinical effectiveness of bone marrow concentrator modified allograft (BMCA) versus bone marrow aspirate mixed allograft (BMAA) for children with COM of long bones. Between January 2013 and December 2017, 26 young patients with COM were enrolled. Different bone grafts were applied to repair bone defects secondary to IMT procedure for infection eradication. Group BMCA was administered BMCA while Group BMAA was given BMAA. The results of this case-control study were retrospectively analyzed.Aims
Methods
The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis
Introduction:. A surgical hip dislocation provides circumferential access to the femoral head and is essential in the treatment pediatric and adult hip disease. Iatrogenic injury to the femoral head blood supply during a surgical may result in the osteonecrosis of the femoral head. In order to reduce vessel injury and incidence of AVN, the Greater Trochanteric Osteotomy (GTO) was developed and popularized by Ganz. The downside of this approach is the increased morbidity associated with the GTO including non-union in 8% and painful hardware requiring removal in 20% of patients. (reference) Recent studies performed at our institution have mapped the extra-osseous course of the medial femoral circumflex artery and provide surgical guidelines for a vessel preserving posterolateral approach. In this cadaveric model using Gadolinium enhanced MRI, we investigate whether standardized alterations in the postero-lateral surgical approach may reliably preserve femoral head vascularity during a posterior surgical hip dislocation. Methods:. In 8 cadaveric specimens the senior author (ES) performed a surgical hip dislocation through the posterolateral approach with surgical modifications designed to protect the superior and inferior retinacular arteries. In every specimen the same surgical alterations were made using a ruler: the Quadratus Femoris myotomy occurred 2.5 cm off its trochanteric insertion, the piriformis tenotomy occurred at its insertion and extended obliquely leaving a 2 cm cuff of conjoin tendon (inferior gemellus), and the Obturator Externus (OE) was myotomized 2 cm off its trochanteric insertion. (Figure 1) For the capsulotomy, the incision started on the posterior femoral neck directly beneath the cut obturator externus tendon and extending posteriorly to the acetabulum. Superior and inferior extensions of the capsulotomy ran parallel to the acetabular rim creating a T-shaped capsulotomy. After the surgical dislocation was complete, the medial femoral circumflex artery (MFCA) was cannulated and Gadolinium-enhanced MRI performed in order to assess intra-osseous femoral head perfusion and compared to the gadolinium femoral head perfusion of the contra-lateral hip as a non-operative control. Gross-dissection after polyurethane latex injection in the cannulated MFCA was performed to validate MRI findings and to assess for vessel integrity after the surgical dislocation. Results:. In 8 cadaveric specimens MRI quantification of femoral head perfusion was 94.3% and femoral head-neck junction perfusion was 93.5% compared to the non-operative control. (Figure 2) Gross dissection after latex injection into the MFCA demonstrated intact superior and inferior retinacular arteries in all 8 specimens. (Figure 3). Discussion and Conclusions:. In this study, perfusion to the femoral head and head-neck junction is preserved following posterior surgical dislocation through the postero-lateral approach. These preliminary findings suggest that specific surgical modifications can protect and reliably maintain vascularity to the femoral head after surgical hip dislocation. This approach may benefit hip resurfacing and potentially decease risk of femoral neck fracture
Partial knee arthroplasty (PKA), either medial
or lateral unicompartmental knee artroplasty (UKA) or patellofemoral arthroplasty
(PFA) are a good option in suitable patients and have the advantages
of reduced operative trauma, preservation of both cruciate ligaments
and bone stock, and restoration of normal kinematics within the
knee joint. However, questions remain concerning long-term survival.
The goal of this review article was to present the long-term results
of medial and lateral UKA, PFA and combined compartmental arthroplasty
for multicompartmental disease. Medium- and long-term studies suggest
reasonable outcomes at ten years with survival greater than 95% in
UKA performed for medial osteoarthritis or osteonecrosis, and similarly
for lateral Cite this article:
Approved by the Food and Drug Administration in 2004, the Phase
III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis
(AMOA) in patients with an intact anterior cruciate ligament. This
unicompartmental knee arthroplasty (UKA) is relatively new in the
United States, and therefore long-term American results are lacking. This is a single surgeon, retrospective study based on prospectively
collected data, analysing a consecutive series of primary UKAs using
the Phase III mobile-bearing Oxford Knee and Phase III instrumentation. Between July 2004 and December 2006, the senior author (RHE)
carried out a medial UKA in 173 patients (213 knees) for anteromedial
osteoarthritis or avascular necrosis (AVN). A total of 95 patients were men and 78 were women. Their mean
age at surgery was 67 years (38 to 89) and mean body mass index
29.87 kg/m2 (17 to 62). The mean follow-up was ten years (4 to 11).Aims
Patients and Methods