Introduction. Stryde® lengthening nail has been recently withdrawn because of concerns about osteolysis and other bone lesions that have been observed early after implantation. The present study analyses the incidence and features of these bone lesions in our patients. Materials and Methods. This is a retrospective review of a series of patients from two centres specializing in limb reconstruction. Inclusion criteria was a history of surgery with Stryde® lengthening nail with more than one year follow-up available. All postoperative x-rays were and clinical notes were reviewed. Results. 36 patients with 75 bone segments were included. 11 (30.5%) patients and 32 (42.6%) bone segments were without any lesion. In 3 (8.3%) patients and 3 (4%) segments, osteolytic lesions only were noticed. 11(30.5%) patients and 14 (18.6%) segments had combined
Salmonella osteomyelitis occurs infrequently in children without a sickle cell disease, and its subacute form is rare. Diagnosis is often delayed because its slow onset, intermittent pain and it can be confused with bone tumors. An otherwise healthy 13-year-old boy was admitted from another center in order to discard bone tumor in proximal tibia, with compatible radiologic findings. There was no history of trauma or previous illness. Twenty days ago, he had flu symptoms and myalgia. On the physical examination the child was feverless, showed increased heat over his left knee, considerable effusion and painful restriction of movement. Inflammatory laboratory results revealed erythrocyte sedimentation rate 46mm/h and C-Reactive protein, 11,2 mg/L. Radiographs revealed a
Chronic calcaneal osteomyelitis is a rare and not usually part of the initial differential diagnosis of pseudotumoral calcaneal lesions. Presentation of surgical and functional outcomes of a case of a total calcanectomy. This can be seen as a foot rescue alternative in patients with chronic calcaneal osteomyelitis. We present the case of a 60 year- old patient with complaints of diffuse and intermittent pain in the left heel with 3 years of evolution. Radiographically,
With cementless porous-coated acetabular replacements, extensive bone loss can occur without effecting implant stability. As a result, the surgeon is frequently faced with re-operating on a well-fixed cementless acetabular component with osteolysis and must decide whether or not to remove a well-fixed porous coated socket. A classification system and treatment algorithm has been developed to aid in management decisions regarding re-operation for polyethylene wear and pelvic osteolysis. Cases are classified into one of 3 possible categories depending on the radiographic stability of the porous coated shell and the ability to replace the polyethylene liner. Type I case; stable porous coated shell, liner replaceable; Type II case; socket stable, liner not replaceable;. Type III case; socket loose, not osseointegrated. Treatment Algorithms - Retain well-fixed shell in Type I cases and replace the liner. Debride accessible
Reoperation on the acetabular side of the total hip arthroplasty construct because of acetabular liner wear with or without extensive osteolysis is the most common reoperation performed in revision hip surgery today. The options of revision of the component or component retention, liner exchange (cemented or direct reinsertion) and bone grafting represent a classic surgeon dilemma of choices and compromises. CT scanning is helpful in determining the size and location of osteolytic lesions. My preference is to retain the existing shell when possible especially when there are large osteolytic lesions but where structural support is maintained. The advantages of complete revision are easy access to
Prevention: Many periprosthetic femur fractures may be prevented by: good patient follow-up; timely reoperation of
With cementless porous-coated acetabular replacements, extensive bone loss can occur without affecting implant stability. As a result, the surgeon is frequently faced with re-operating on a well-fixed cementless acetabular component with osteolysis and must decide whether or not to remove a well-fixed porous coated socket. A classification system and treatment algorithm has been developed to aid in management decisions regarding re-operation for polyethylene wear and pelvic osteolysis. Cases are classified into one of 3 possible categories depending on the radiographic stability of the porous coated shell and the ability to replace the polyethylene liner. Type I case; stable porous coated shell, liner replaceable; Type II case; socket stable, liner not replaceable; Type III case; socket loose, not osseointegrated. Relative Contra-indications for Liner Exchange – Type II Case - Malpositioned socket, Severely damaged shell or lock detail (consider cementing shell in place), Poor track record of the implant, Highly crosslinked polyethylene liner of adequate thickness not available, Ongrowth (as opposed to ingrowth) fixation surface. Treatment Algorithm. Type I Case: Retain well-fixed shell in Type I cases and replace the liner. Debride accessible
Background. The procedures of total elbow and shoulder replacements increased 6% to 13% annually from 1993 to 2007 with revision-related burden increasing from 4.5% to 7%. The revisions of the shoulder and elbow prostheses due to aseptic loosening, periprosthetic fractures, infections have led to the use of standard or custom-made implants due to significant bone loss. This study reports our experience in the management of complicated primary and revisions of total shoulder and elbow replacements with significant humeral bone loss and in metabolic diseases of the elbow and shoulder treated with bone resection using The Mosaic Humeral Replacement System. Patients and Materials. A total of 20 patients underwent total elbow or shoulder arthroplasty using the Mosaic Humeral Replacement System (Biomet, UK). The Mosaic system was used in 8 shoulder arthroplasties (Group A) and in 12 elbow arthroplasties (Group B). The underlying pathologis in Group A included 2 malunited proximal humerus fracture, 1 humeral osteomyelitis, 1 shoulder chondrosarcoma, 1 aggressive Gigantic Cell Tumor with prosthetic fracture, 2 metastatic