共查询到20条相似文献,搜索用时 31 毫秒
1.
2.
3.
Alberto Ventura Clara Terzaghi Claudio Legnani Enrico Borgo 《Archives of orthopaedic and trauma surgery》2014,134(2):263-268
Introduction
Chronic ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. In case of severe joint laxity, surgical treatment with reconstruction of the lateral ligamental complex is recommended. The aim of this study was to evaluate the functional outcome of patients treated with lateral ligament reconstruction with allograft for severe chronic lateral ankle instability.Materials and methods
We performed a retrospective cohort study of ten patients who underwent allograft external non-anatomic ligamentoplasty for severe chronic lateral ankle instability between 2009 and 2011, with an average follow-up of 16.3 months (SD 8.2). Median age at surgery was 29 years (range 25–35). All patients presented both ATFL and CFL lesion. Patients were evaluated using American Orthopaedic Foot and Ankle Society score, Karlsson–Peterson score, Tegner activity level, Sefton stability scale, and objective examination comprehending range of motion, anterior drawer sign and talar tilt test. Telos stress equipment was used for pre- and post-operative radiographic laxity testing.Results
Follow-up examination at an average of 16.3 months (SD 8.2) after surgery showed significant improvement of all variables compared to pre-operative values (p < 0.001). Most patients rated their outcome as good/excellent. Telos stress radiographs documented improvement in joint stability.Conclusions
Lateral ligament reconstruction with allograft represents a valid treatment option in patients with severe chronic lateral ankle instability. 相似文献4.
5.
6.
Jean Louis Prudhon François Steffann André Ferreira Régis Verdier Thierry Aslanian Jacques Caton 《International orthopaedics》2014,38(12):2463-2468
Purpose
Dislocation is a frequent complication in total hip arthroplasty (THA) revision. Cup fixation is the second concern. In order to know outcomes at two years, we prospectively followed a continuous series of 78 patients to demonstrate that cementless dual-mobility cup (DMC) used in revision THA is safe as regards dislocation risk and bone fixation.Method
We enrolled 78 consecutive patients (79 cases) in a prospective study. Mean interval between index surgery and revision was 12.9 years. Mean age at revision was 75.5 years. Two types of cementless DMC were used: a standard DMC in 68 cases with low-grade bone defect (Paprosky grade 1 and 2), and a specific design reconstruction DMC in 11 cases with severe bone loss (Paprosky grade 3).Results
At two years of follow-up, 68 patients were reviewed; four were lost to follow-up., and six patients were deceased. We identified three types of situations at risk:standard risk (33 cases), Paprosky grade 1 or 2; medium risk (37 cases), revision for recurrent instability (21), periprosthetic fractures (14) or severe loosening Paprosky grade 3 without femorotomy (2); high risk (nine cases), revision for severe loosening with a femorotomy. One (1.3 %) patient dislocated her hip at one month without recurrence. Revision rate for dislocation was 0 %; two (2.7 %) early mechanical failures occurred.Conclusion
Considering outcomes of this series, cementless DMC can be suggested in THA revision surgery. 相似文献7.
8.
Eduardo García-Rey Ricardo Fernández-Fernández David Durán Rosario Madero 《Journal of orthopaedics and traumatology》2013,14(1):39-49
Background
The preoperative bone defect and the reconstruction of the center of rotation of the hip are critical in acetabular revision surgery. Uncemented oblong cups are employed in order to manage these issues. We analyzed the clinical results and rates of revision of two different uncemented oblong cups, the reconstruction of the center of rotation of the hip, as well as the rate of radiological loosening and possible risk factors.Materials and methods
Forty-five patients (46 hips) underwent acetabular revision surgery using two different uncemented oblong cups. We assessed the clinical results and the survival rate for revision and aseptic loosening. Intraoperative bone loss was classified according to Paprosky, and acetabular reconstruction was assessed according to Ranawat. The mean follow-up was 7.2 years (range 4–11 years).Results
There were four re-revisions (three due to aseptic loosening); the survival rate for re-revision due to aseptic loosening was 60.1 % at seven years. The mean distance between the center of the femoral head prosthesis and the approximate center of the femoral head improved from 21.5 to 10.2 mm. Thirteen cups showed radiological loosening; the survival rate for radiological loosening at seven years was 40.54 %. A smaller postoperative horizontal distance was correlated with cup loosening.Conclusions
Although optimal acetabular reconstruction can be achieved by using oblong uncemented cups in revision hip surgery, the clinical and radiological results are not encouraging. Excessive medialization of the cup may increase the rate of loosening. 相似文献9.
10.
Philippe Hernigou Jacques Pariat Steffen Queinnec Yasuhiro Homma Charles Henri Flouzat Lachaniette Nathalie Chevallier Helene Rouard 《International orthopaedics》2014,38(9):1913-1921
Purpose
The procedure of bone allografting associated with a reinforcement device is widely used for acetabulum revision. However in absence of biologic fixation of the allograft, failure of the reconstruction may occur. We made the hypothesis that it would be possible to load these grafts with bone marrow derived mesenchymal stem cells (MSC) to rescue the osteogenic capacity of an allogenic dead bone and therefore enhance incorporation of allografts with the host bone and decrease the number of failures related to the allograft.Method
We identified 60 patients who had undergone acetabular component revision for aseptic failure of cemented implants associated with massive periacetabular osteolysis and Paprosky type 3A or 3B classification (without pelvic discontinuity) between 1996 and 2001. The study group of 30 patients received MSCs in the allograft and at the host graft junction. The average total number of MSCs received by each patient was 195,000 cells (range 86,000–254,000 cells). The control group of 30 patients had no MSCs in the allograft. Patients were matched for the size of periacetabular osteolysis (Paprosky type 3A or 3B). We compared the evolution of the allografts and evaluated cup migration and revision of the hips as end points at a minimum of 12 years or until failure.Result
Better radiographic graft union rates and less allograft resorption were observed with allografts loaded with stem cells. Allograft resorption was significantly decreased in the group with allograft loaded with MSCs (1.2 cm2 —range 0–2.3 cm2—of resorption on radiographs in the group with MSCs; versus 6 cm2, range 2.1–8.5 cm2 in the group without MSCs). The rate of mechanical failure was highest (p?=?0.01) among the 30 patients with allograft without stem cells (9/30; 30 %) compared with no failures for patients with allograft loaded with stem cells. Revision of the cup was necessary in nine patients in the control group. No revision was performed in the 30 patients of the study group with MSCs.Conclusion
For acetabular defect reconstruction, loading the allograft with MSCs has resulted in a lower rate of failure as compared with allograft without MSCs. 相似文献11.
Hans Christian Plaschke Theis Thillemann Anne Kathrine Belling-Sørensen Bo Olsen 《International orthopaedics》2013,37(5):853-858
Purpose
In this retrospective study we evaluated the short- to medium-term results after 20 Coonrad-Morrey revision total elbow arthroplasties (TEAs).Methods
We included a consecutive series of revision TEAs performed at our institution from 2004 to 2010. At a mean follow-up of 4.4 years, patients were evaluated using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES) and standard radiographs.Results
The mean age at revision TEA was 65.8 years. The median time of implant survival for primary prosthesis was 9.5 years. The mean post-operative MEPS was 79. The mean OES was 58, 66 and 53 for function, pain and social-psychological dimensions, respectively. At follow-up the range of motion had improved significantly. There were two cases of radiolucent lines and two cases of minor bushing wear; however, none of the implants were clinically loose. In one case deep infection led to a further revision. Two patients had post-operative ulnar nerve paraesthesia.Conclusions
Results after revision TEA using the Coonrad-Morrey prosthesis are acceptable with a low short- to midterm failure rate. Revision improves range of motion and provides pain relief. One case of deep infection with recurrent revision is of concern. The treatment can be used as an option for failed TEA. 相似文献12.
Clemens Baier Christian Lüring Jens Schaumburger Franz Köck Johannes Beckmann Markus Tingart Florian Zeman Joachim Grifka Hans-Robert Springorum 《Journal of orthopaedic science》2013,18(6):955-961
Background
Revision total knee arthroplasties (TKA) have been performed with increasing frequency over the last 25 years.Methods
In this study, we retrospectively analyzed 78 patients who underwent 78 revision TKAs during the years 2003–2007 with an average follow-up of 81 months (range 60–108 months). All patients were treated with a standard rotating hinge prosthesis (TC3, DePuy, Warsaw, IN, USA) due to significant instability. We evaluated the postoperative results using the Knee Society clinical rating system and the WOMAC rating system.Results
Clinical results revealed significant improvements in both scores. Complications occurred in almost one-third of the cases, with a reoperation rate of 26 %.Conclusion
Our mid-term findings show that revision TKAs lead to an improvement in patient-perceived outcomes of physical variables. While revision TKA is a useful option for patients, procedure-associated complications should not be neglected. During the course of the procedure, it is important to collect patient-oriented data and focus on responsive and valid scores. 相似文献13.
14.
Jitesh Kumar Jain Saurabh Agarwal Rajeev K. Sharma 《Journal of orthopaedic science》2014,19(4):564-570
Background
We aimed to assess the results of ligament reconstruction/advancement for the management of ligament insufficiency during total knee arthroplasty.Method
We retrospectively reviewed the results of ligament reconstruction/advancement for management of instability due to ligament insufficiency during total knee arthroplasty (TKA). Between January 2001 and January 2008 collateral ligament reconstruction/advancement was done in 15 patients. Wherever ligament advancement was not possible (mid-substance tear) ligament reconstruction was done using the hamstring tendon. Knee society scores were calculated and Kaplan–Meier survival analysis was done.Results
Average follow-up was 6.2 years. No patient developed instability until the last follow-up, except one patient who required revision due to instability at six years after primary surgery.Conclusion
We concluded from this study that ligament reconstruction/advancement during TKA is a viable option to address instability due to ligament insufficiency. 相似文献15.
16.
17.
Hong-jiang Ruan Shen Liu Cun-yi Fan Jun-jian Liu 《Archives of orthopaedic and trauma surgery》2013,133(2):179-185
Background
An ankylosed elbow is defined as an elbow having a range of motion of 0°. Movement is extremely limited. This study retrospectively analyzes the results of arthrolysis and hinged external fixation performed on 15 patients suffering from ankylosed elbows.Methods
Fifteen completely ankylosed elbows were treated by arthrolysis and hinged external fixation. Patients comprised nine men and six women, with a mean age of 37.93 years (37.93 ± 9.68) when arthrolysis was performed. Before surgery, the elbows were ankylosed at various angles ranging from 30° to 85°. Eleven patients underwent arthrolysis by medial and lateral approaches, three patients by the posterior approach, and one patient by posterior and lateral approaches. Hinged external fixators were applied to all patients. Subcutaneous anterior transposition of the ulnar nerve was performed in all patients.Result
All patients received satisfactory follow-up. The range of motion of the elbow improved from 0° preoperatively to a postoperative mean of 115.67° (115.67 ± 23.29). The Mayo Elbow Performance Score improved from a mean of 67.67 ± 11.00 to 86.67 ± 8.38 points, with excellent results in nine patients, good in five, and fair in one. This difference is statistically significant (t = ?6.862; p < 0.001).Conclusion
Open arthrolysis and monolateral hinged external fixation are effective in treating posttraumatic ankylosed elbow. Arthrolysis should be performed by a combination of lateral and medial approaches. In addition, routine hinged external fixation and anterior transposition of the ulnar nerve may improve the postoperative recovery of elbow stiffness. 相似文献18.
19.
Madlaina Schöni Susann Drerup Felix Angst Diego Kyburz Beat R. Simmen Jörg Goldhahn 《Archives of orthopaedic and trauma surgery》2013,133(10):1415-1424