1
|
Zachariadis CB, Leligou HC, Kourkoulis SK, Magnisalis E, Papagelopoulos PJ, Savvidou OD. Complications Following Intraosseous Injections of Calcium Phosphate Bone Cement in Subchondroplasty. J Long Term Eff Med Implants 2024; 34:15-22. [PMID: 38842229 DOI: 10.1615/jlongtermeffmedimplants.2023049584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
An alternative approach to the major problem of osteoarthritis that has begun to pique the interest of researchers focuses on the pathology of the subchondral bone, its constant cross-talk with the articular cartilage, and its interaction with the joint. The presence of bone marrow lesions, detectable on MRI scans, has proven to be a cause of pain as well as a predictor of the progression of degenerative changes. Subchondroplasty is a relatively new surgical procedure for the treatment of these lesions, in which injectable calcium phosphate bone cement is infused into the affected area percutaneously, under fluoroscopic guidance. In its use as a synthetic scaffold, calcium phosphate bone cement exhibits considerable osteoconductivity, bioabsorbability, and low toxicity, thus showing great potential for restoring subchondral biomechanical properties through structural remodeling. Although published results appear quite promising, there are certain complications that the surgeon should be aware of. We reviewed the published data regarding complications of the procedure, highlighting possible causes according to these data, and suggesting safety measures. Avascular necrosis of the talus is the most reported concern. Postsurgical pain, infection, and continuous wound drainage due to bone substitute material extravasation to the joint or soft tissue are also mentioned, necessitating further standardization of the procedure. There are no reports of permanent postoperative disability or fatal outcomes.
Collapse
Affiliation(s)
| | - Helen C Leligou
- University of West Attica, Dept. of Industrial Design and Production Engineering P. Ralli & Thivon 250, 12244 Aigaleo, Athens, Greece
| | - Stauros K Kourkoulis
- National Technical University of Athens, SAMPS, Department of Mechanics Athens, Attiki, Greece
| | - Evaggelos Magnisalis
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 12462, Athens, Greece; National Technical University of Athens, SAMPS, Department of Mechanics Athens, Attiki, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedics, National and Kapodistrian University of Athens, Atikon University General Hospital, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, GREECE
| |
Collapse
|
2
|
Tadje JM, Daines SB. Embolism After Injection of a Calcium Sulfate Bone Graft Substitute: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00048. [PMID: 36137174 DOI: 10.2106/jbjs.cc.22.00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
CASE A 66-year-old man presented with new left hip pain after total hip arthroplasty 21 years earlier. Computed tomography imaging revealed massive osteolysis involving the ileum behind the well-fixed acetabular component. The patient was indicated for head and liner exchange with grafting of the osteolytic lesion. Surgery was complicated by cardiopulmonary arrest after injection of a bone graft substitute into the lesion. Despite resuscitation attempts, the patient died. CONCLUSION Embolism is a rare complication of bone graft substitute injection for pelvic osteolysis. This material can extravasate from bone and deposit in the pulmonary and cerebral microcirculation.
Collapse
Affiliation(s)
- Jacob M Tadje
- University of Washington School of Medicine, Seattle, Washington
| | | |
Collapse
|
3
|
Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:jcm11123265. [PMID: 35743336 PMCID: PMC9225477 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
Collapse
|
4
|
Cazzato RL, Garnon J, Dalili D, Autrusseau PA, Auloge P, De Marini P, Buy X, Palussiere J, Gangi A. Percutaneous Osteoplasty in long bones: current status and assessment of outcomes. Tech Vasc Interv Radiol 2022; 25:100803. [DOI: 10.1016/j.tvir.2022.100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Wood D, Mollabashy A. Vascular extravasation of injectable bioresorbable bone cement during aspiration and injection of calcaneal bone cyst. Proc (Bayl Univ Med Cent) 2020; 34:189-190. [PMID: 33456197 DOI: 10.1080/08998280.2020.1801105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A 27-year-old woman underwent aspiration and bioresorbable cement injection of a simple bone cyst. During injection, cement was seen on fluoroscopy extravasating into the posterior vein of the ankle. The procedure was immediately stopped, and the patient remained hemodynamically stable. Vascular leakage of bone cement during injection of a bone cyst is rare but can have catastrophic consequences.
Collapse
Affiliation(s)
- Dorian Wood
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Allaaddin Mollabashy
- Department of Orthopedic Surgery, Baylor University Medical Center, Dallas, Texas
| |
Collapse
|
6
|
Cazzato RL, Garnon J, Shaygi B, Boatta E, Koch G, Palussiere J, Buy X, Gangi A. Percutaneous consolidation of bone metastases: strategies and techniques. Insights Imaging 2019; 10:14. [PMID: 30725322 PMCID: PMC6365313 DOI: 10.1186/s13244-019-0709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with cancer can present with bone metastases (BM), which are frequently complicated by different types of fractures necessitating prompt management to avoid serious impairment in terms of quality of life and survival. Percutaneous image-guided bone consolidation has rapidly emerged as an alternative to surgical fixation and is mainly reserved for patients who are deemed unfit for surgical management. Two percutaneous techniques, osteoplasty and osteosynthesis, are available and are selected based on the biomechanics of the target bones as well as the fracture types. The aim of this narrative review is to present the different types of BM-related fractures and the interventional strategies and techniques underpinning their minimally invasive percutaneous fixation.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Benham Shaygi
- Department of Interventional Radiology, Royal Devon and Exeter Hospital NHS Trust, Barrack Rd, Exeter, EX2 5DW, UK
| | - Emanuele Boatta
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| |
Collapse
|
7
|
Chiu SY, Wan KW. Use of Three-Dimensional Printing Techniques in the Management of a Patient Suffering From Traumatic Loss of the Talus. J Foot Ankle Surg 2019; 58:176-183. [PMID: 30583778 DOI: 10.1053/j.jfas.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 02/03/2023]
Abstract
Traumatic loss of the whole talus is extremely rare, and its possible treatment options are limited. Our experience of treatment of a 30-year-old male suffering from traumatic loss of the whole talus with the insertion of an anatomical antibiotic-loaded talus cement spacer using 3-dimensional printing techniques as an interim measure was reviewed and reported. A young motorcyclist was brought to the emergency department after a road traffic accident. He sustained multiple injuries including traumatic loss of his left talus. Despite repeated surgeries of debridement and insertion of external fixator to his injured ankle, the patient had residual problem of ankle instability, ankle infection, and absence of his involved talus. With the help of computerized 3-dimensional printing techniques, an anatomical talus cement spacer was produced in the operating room and inserted into the patient's ankle 7 weeks after the initial trauma. The external fixator was kept for another 3 weeks before removal. At 14 months after the insertion of cement spacer, the patient could walk independently without any pain for 15 minutes with the help of a crutch occasionally. However, the range of motion of his left ankle was limited to 15° in the flexion-extension arc and minimal subtalar motion. The infection of the left ankle was under control.
Collapse
Affiliation(s)
- Shin-Yeung Chiu
- Consultant, Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
| | - Kin-Wah Wan
- Prosthetist Orthotist, Department of Prosthetic and Orthotic, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| |
Collapse
|
8
|
Buy X, Catena V, Roubaud G, Crombe A, Kind M, Palussiere J. Image-Guided Bone Consolidation in Oncology. Semin Intervent Radiol 2018; 35:221-228. [PMID: 30402004 DOI: 10.1055/s-0038-1669468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Occurrence of bone metastases is a common event in oncology. Bone metastases are associated with pain, functional impairment, and fractures, particularly when weight-bearing bones are involved. Management of bone metastases has been improved by the development of various interventional radiology consolidation techniques. Cementoplasty is based on injection of acrylic cement into a weakened bone to reinforce it and to control pain. This minimally invasive technique has proven its efficacy for flat bone submitted to compression forces. However, resistance to torsion forces is limited and, thus, treatment of long bones should be considered with caution. In recent years, variant techniques of percutaneous bone consolidation have emerged, including expansion devices for vertebral augmentation and percutaneous screw fixation for pelvic bone and proximal femur tumors. Research projects are ongoing to develop drug-loaded cements to use them as therapeutic vectors. However, release of drugs is still poorly controlled and conventional polymethylmethacrylate cement remains the gold standard in oncology. Image-guided consolidation techniques enhance the array of treatments in bone oncology. Multidisciplinary approach is mandatory to select the best indications.
Collapse
Affiliation(s)
- Xavier Buy
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Vittorio Catena
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Amandine Crombe
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Michèle Kind
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Jean Palussiere
- Department of Radiology, Institut Bergonie, Bordeaux, France
| |
Collapse
|
9
|
Cazzato RL, Arrigoni F, Boatta E, Bruno F, Chiang JB, Garnon J, Zugaro L, Giordano AV, Carducci S, Varrassi M, Beomonte Zobel B, Bazzocchi A, Aliprandi A, Basile A, Marcia S, Masala S, Grasso RF, Squarza S, Floridi C, Ierardi AM, Burdi N, Cioni R, Napoli A, Niola R, Rossi G, Rossi UG, Venturini M, De Cobelli F, Carotti M, Gravina GL, Di Staso M, Zoccali C, Biagini R, Tonini G, Santini D, Carrafiello G, Cariati M, Silvestri E, Sconfienza LM, Giovagnoni A, Masciocchi C, Gangi A, Barile A. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2018; 124:34-49. [DOI: 10.1007/s11547-018-0938-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
|
10
|
Abstract
As an extension of percutaneous vertebroplasty (PVP), percutaneous osteoplasty (POP) refers broadly to percutaneous bone cement injected into various parts of the body and narrowly to cement injected into extraspinal bone lesions. POP mainly includes such surgeries as percutaneous sacroplasty, percutaneous acetabuloplasty, percutaneous femoral osteoplasty, and percutaneous iliac osteoplasty (Figure 1). Currently, POP is a positive and an effective treatment for extraspinal bone lesions in that it can rapidly relieve pain, effectively prevent pathological fractures, and partially inactivate tumors, with few complications. The aim of this review is to detail the POP techniques and report their safety and efficacy in the treatment of extraspinal metastases.
Collapse
Affiliation(s)
- Qinghua Tian
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Yongde Cheng
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Chungen Wu
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| |
Collapse
|
11
|
Uncommon observation of bifocal giant subchondral cysts in the hip: diagnostic role of CT arthrography and MRI, with pathological correlation. Skeletal Radiol 2018; 47:587-592. [PMID: 29164284 DOI: 10.1007/s00256-017-2819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
Subchondral cysts (or geodes) are common in osteoarthritis (OA), usually in association with other typical signs, i.e., joint space narrowing, subchondral bone sclerosis, and osteophytosis. However, large lesions without the typical signs of OA or lesions located outside the weight-bearing areas are unusual and may be confused for other conditions, in particular, those of tumoral origin. We report the findings in a 48-year-old man who had been complaining of left buttock pain for 3 years, getting worse over the last year, and an evolutive limited range of motion of the hip. The pain was increased by weight-bearing and was not relieved by nonsteroidal anti-inflammatory drugs. Radiographs and CT showed a large multilocular lytic lesion within the femoral head and a large lytic lesion in the left ilio-ischiatic ramus, raising the question of bifocal tumoral involvement. On MRI, the lesions had low signal intensity on T1- and high signal intensity on T2-weighted MR images, with subtle peripheral enhancement on post-contrast T1-weighted images. CT arthrography, by demonstrating a communication between the femoral head and ischiatic cysts and the joint space allowed us to definitively rule out malignant conditions and to make the diagnosis of subchondral bone cysts. Total hip arthroplasty was performed. Pathological analysis of the resected femoral head and of material obtained at curettage of the ischiatic lesion confirmed the diagnosis of degenerative geodes. This case illustrates an atypical bifocal location of giant subchondral cysts in the hip joint mimicking lytic tumors, in the absence of osteoarthritis or rheumatoid arthritis, and highlights the role of CT arthrography in identifying this condition.
Collapse
|
12
|
Technique for 3-Dimesional (3D) Modeling of Osteoarticular Medial Femoral Condyle Vascularized Grafting to Replace the Proximal Pole of Unsalvagable Scaphoid Nonunions. Tech Hand Up Extrem Surg 2017; 20:117-24. [PMID: 27466049 DOI: 10.1097/bth.0000000000000129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study describes a novel technique for the preoperative surgical planning for an osteoarticular medial femoral condyle (MFC) graft to replace the proximal pole of a scaphoid. In cases of proximal pole scaphoid nonunion or in Preiser disease, fragmentation of the articular surface can occur, leading to significant pain and disability. Osteoarticular MFC bone grafting can be used to treat these injuries by providing a vascularized osteoarticular surface. Using 3-dimensional imaging and printing we are able to precisely model the injured scaphoid, and also accurately plan the harvest of MFC osteoarticular graft. This technique allows for accurate preoperative planning of a complex 3-dimensional bone, and has improved our execution of the plan intraoperatively.
Collapse
|
13
|
Buy X, Cazzato RL, Catena V, Roubaud G, Kind M, Palussiere J. [Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation]. Bull Cancer 2017; 104:423-432. [PMID: 28320522 DOI: 10.1016/j.bulcan.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 10/19/2022]
Abstract
Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications.
Collapse
Affiliation(s)
- Xavier Buy
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - Roberto Luigi Cazzato
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Vittorio Catena
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Guilhem Roubaud
- Institut Bergonié, département d'oncologie médicale, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Michele Kind
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| |
Collapse
|
14
|
Cazzato RL, Garnon J, Tsoumakidou G, Koch G, Palussière J, Gangi A, Buy X. Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological/insufficiency fractures of the femoral neck in non-surgical cancer patients. Eur J Radiol 2017; 90:1-5. [PMID: 28583620 DOI: 10.1016/j.ejrad.2017.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/02/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Abstract
AIM To present percutaneous image-guided screw-mediated osteosynthesis (PIGSMO) for fixation of impending fractures (ImF) and non-displaced/mildly displaced pathological/insufficient fractures (PF/InF) of the femoral neck in non-surgical cancer patients. MATERIALS AND METHODS This is a double-centre single-arm observational study. Retrospective review of electronic records identified all oncologic patients who had undergone femoral neck PIGSMO. Inclusion criteria were: non-displaced or mildly displaced PF/InF, and ImF (Mirels' score ≥8); life expectancy ≥1 month; unsuitability for surgical treatment due to sub-optimal clinical fitness, refusal of consent, or unacceptable delay to systemic therapy. RESULTS Eleven patients were treated (mean age 63.7±13.5 years) due to ImF (63.6%, mean Mirels' score 10.1), PF (27.3%) or post-radiation InF (9.1%) under CT/fluoroscopy- (36.4%) or CBCT- (63.6%) guidance. Thirty-two screws were implanted and cement injection was added in 36.4% cases. Technical success was 90.9%. No procedure related complications were noted. At 1-month clinical follow-up (pain/walking impairment), 63.6% and 27.3% patients reported significant and mild improvement, respectively. Imaging follow-up (available in 63.6% cases) showed no signs of secondary fractures, neither of screws loosening at mean 2.8 months. Five patients (45.5%) died after PIGSMO (mean time interval 3.6 months). CONCLUSIONS PIGSMO is technically feasible and safe in cancer patients with limited life expectancy; it offers good short-term results. Further prospective studies are required to corroborate mid- and to prove long-term efficacy of the technique.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Jean Palussière
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Xavier Buy
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| |
Collapse
|
15
|
Rapid chondrolysis of the medial knee compartment after arthroscopic meniscal resection: a case report. J Med Case Rep 2016; 10:81. [PMID: 27039072 PMCID: PMC4818872 DOI: 10.1186/s13256-016-0841-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/16/2016] [Indexed: 11/27/2022] Open
Abstract
Background Rapidly destructive osteoarthritis of the hip and rapid chondrolysis of the lateral compartment of the knee or the shoulder are rare, but have been previously described in the medical literature. To the best of our knowledge, no case of medial femorotibial compartment chondrolysis after arthroscopy has yet been described. We therefore submit the first case report. Case presentation A 64-year-old white European man presented with right knee pain due to a medial meniscal tear with no other abnormality found on examination or imaging. An arthroscopic partial medial meniscectomy was performed and early evolution was favorable with no signs of infection. He developed knee pain 2 months later. X-rays showed a thinning of the medial compartment which was confirmed by computed tomography arthrogram. There was no articular effusion, mobility was conserved (0/0/125°), there was no laxity, and pain was localized to the medial femorotibial compartment, with no meniscal signs. There was a 8° varus deviation (versus 3° for his uninjured left knee). His blood work was normal. As there were no signs of infection, no aspiration was performed. Viscosupplementation was offered but refused by the patient. He is now waiting for a partial knee replacement. Conclusions To the best of our knowledge, this is the first description of such a case. Rapid chondrolysis has been described in the hip, shoulder, and the lateral compartment of the knee. Infiltration of bupivacaine and lateral meniscectomy are the most frequently sited offending procedures. Concerning the medial compartment, cases of avascular necrosis have been reported after meniscectomy or use of radiofrequency devices. This case underlines the necessity of a thorough physical examination and complete radiological work up before any surgery. It must also drive us to use caution regarding meniscectomy, especially in patients over 60 years of age, and reminds us that patients must be informed of this potential complication.
Collapse
|
16
|
Cazzato RL, Palussière J, Buy X, Denaro V, Santini D, Tonini G, Grasso RF, Zobel BB, Poretti D, Pedicini V, Balzarini L, Lanza E. Percutaneous Long Bone Cementoplasty for Palliation of Malignant Lesions of the Limbs: A Systematic Review. Cardiovasc Intervent Radiol 2015; 38:1563-72. [DOI: 10.1007/s00270-015-1082-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
|
17
|
Buchko JZ, Gurney-Dunlop T, Shin JJ. Knee chondrolysis by infusion of bupivacaine with epinephrine through an intra-articular pain pump catheter after arthroscopic ACL reconstruction. Am J Sports Med 2015; 43:337-44. [PMID: 25384506 DOI: 10.1177/0363546514555667] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication. PURPOSE To determine the association between postoperative intra-articular infusion of bupivacaine with epinephrine and the development of knee chondrolysis in patients who have undergone arthroscopic anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the development of knee chondrolysis after ACLR is associated with postoperative high-dose intra-articular bupivacaine with epinephrine infusion. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In this retrospective cohort study, the charts of all patients treated with arthroscopic ACLR by a single surgeon between January 1, 2004, and December 31, 2006, were reviewed. Patients with severe articular cartilage damage at the time of the index procedure, with known knee joint infection, inflammatory arthritis, multiligament knee injury, bilateral knee injury, or any previous knee surgery, were excluded. Patients were grouped into 2 cohorts: the exposure group (those who had postoperative infusion of bupivacaine with epinephrine via an intra-articular pain pump [IAPP]) and the nonexposure group (those without postoperative infusion). RESULTS A total of 105 patients met the inclusion and exclusion criteria. There were 57 male and 48 female patients with a mean age at surgery of 25.5 ± 8.6 years (range, 13-52 years). The exposure group consisted of 46 patients and the control group of 59 patients. Thirteen of 46 patients (28.3%) who received an IAPP developed chondrolysis. There were no cases of chondrolysis in the control group. Of those in the exposure group, 32 patients were exposed to 0.5% bupivacaine with epinephrine and 12 developed chondrolysis (37.5%), while 14 patients were exposed to 0.25% bupivacaine with epinephrine and 1 developed chondrolysis (7.1%). Patients exposed to 0.5% bupivacaine with epinephrine had a significantly higher incidence of chondrolysis compared with those exposed to 0.25% (P = .03). Patients with chondrolysis had severe pain and limitations in daily activity. CONCLUSION The development of knee chondrolysis was associated with the intra-articular infusion of bupivacaine with epinephrine postoperatively. Furthermore, the presented evidence suggests that this occurs in a dose-dependent manner. The risk of knee chondrolysis might be reduced by avoidance of intra-articular infusion of bupivacaine with epinephrine. We recommend against continuous intra-articular infusion of local anesthetic postoperatively.
Collapse
Affiliation(s)
- Jordan Z Buchko
- Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tanner Gurney-Dunlop
- Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jason J Shin
- Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
18
|
Cazzato RL, Buy X, Eker O, Fabre T, Palussiere J. Percutaneous long bone cementoplasty of the limbs: experience with fifty-one non-surgical patients. Eur Radiol 2014; 24:3059-68. [DOI: 10.1007/s00330-014-3357-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/03/2014] [Accepted: 07/17/2014] [Indexed: 11/24/2022]
|
19
|
Blazejak M, Hofmann-Fliri L, Büchler L, Gueorguiev B, Windolf M. In vitro temperature evaluation during cement augmentation of proximal humerus plate screw tips. Injury 2013; 44:1321-6. [PMID: 23756264 DOI: 10.1016/j.injury.2013.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of proximal humerus fractures in patients with poor bone quality remains a challenge in trauma surgery. Augmentation with polymethylmethacrylate (PMMA) cement is a possible method to strengthen the implant anchorage in osteoporotic bone and to avoid loss of reduction and reduce the cut-out risk. The polymerisation of PMMA during cement setting leads, however, to an exothermic reaction and the development of supraphysiological temperatures may harm the bone and cartilage. This study addresses the issue of heat development during augmentation of subchondrally placed proximal humerus plate screws with PMMA and the possible risk of bone and cartilage necrosis and apoptosis. METHODS Seven fresh frozen humeri from geriatric female donors were instrumented with the proximal humerus interlocking system (PHILOS) plate and placed in a 37°C water bath. Thereafter, four proximal perforated screws were augmented with 0.5 ml PMMA each. During augmentation, the temperatures in the subchondral bone and on the articular surface were recorded with K-type thermocouples. The measured temperatures were compared to threshold values for necrosis and apoptosis of bone and cartilage reported in the literature. RESULTS The heat development was highest around the augmented tips of the perforated screws and diminished with growing distance from the cement cloud. The highest temperature recorded in the subchondral bone reached 43.5°C and the longest exposure time above 42°C was 86s. The highest temperature measured on the articular surface amounted to 38.6°C and the longest exposure time above 38°C was 5 min and 32s. CONCLUSION The study shows that augmentation of the proximal screws of the PHILOS plate with PMMA leads to a locally limited development of supraphysiological temperatures in the cement cloud and closely around it. The critical threshold values for necrosis and apoptosis of cartilage and subchondral bone reported in the literature, however, are not reached. In order to avoid cement extravasation, special care should be taken in detecting perforations or intra-articular cracks in the humeral head.
Collapse
|
20
|
Maurel B, Le Corroller T, Bierry G, Buy X, Host P, Gangi A. Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement. Skeletal Radiol 2013; 42:43-8. [PMID: 22526875 DOI: 10.1007/s00256-012-1392-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/06/2011] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. MATERIALS AND METHODS Five patients (three men, two women; mean age 35 years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. RESULTS The average amount of bone cement injected was 2.1 ml (range, 0.6-3.5 ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4 weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. CONCLUSIONS Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.
Collapse
Affiliation(s)
- Boris Maurel
- Service de Radiologie Interventionnelle non Vasculaire, Nouvel Hôpital Civil, 1 Place de L'Hôpital, BP 426, 67 091, Strasbourg Cedex, France.
| | | | | | | | | | | |
Collapse
|
21
|
Iannessi A, Amoretti N, Marcy PY, Sedat J. Percutaneous cementoplasty for the treatment of extraspinal painful bone lesion, a prospective study. Diagn Interv Imaging 2012; 93:859-70. [DOI: 10.1016/j.diii.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
22
|
Abstract
Although the disease was first described in the hip, reports of chondrolysis in nearly all diarthrodial joints have since emerged with considerable variations in the literature.Despite speculation among clinicians and researchers about the implicit causal pathways and etiologic contributors associated with chondrolysis, definitive answers remain elusive.The term chondrolysis has been applied to varied levels of joint cartilage destruction from focal chondral defects to diffuse cartilage loss, revealing a lack of consistency in the application of diagnostic criteria to guide differential disease classification.Differentiating between the various potential etiologies associated with chondrolysis provides opportunities for the prevention of the disease.
Collapse
|
23
|
Raaijmaakers M, Mulier M. Percutaneous in situ cementation of a loose femoral stem. J Arthroplasty 2010; 25:1169.e21-4. [PMID: 19577888 DOI: 10.1016/j.arth.2009.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 01/16/2009] [Accepted: 03/10/2009] [Indexed: 02/01/2023] Open
Abstract
This case report describes a patient with aseptic loosening of the femoral component of her total hip arthroplasty 33 years after the initial implantation. The patient was treated with a percutaneous cementation technique using Cortoss (Orthovita, Malvern, Pa) synthetic cortical bone void filler.
Collapse
Affiliation(s)
- Martijn Raaijmaakers
- Department of Orthopedic Surgery, Division of Reconstructive Hip Surgery, University Hospital Leuven, Leuven, Belgium
| | | |
Collapse
|
24
|
Anderson SL, Buchko JZ, Taillon MR, Ernst MA. Chondrolysis of the glenohumeral joint after infusion of bupivacaine through an intra-articular pain pump catheter: a report of 18 cases. Arthroscopy 2010; 26:451-61. [PMID: 20362823 DOI: 10.1016/j.arthro.2010.01.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 01/24/2010] [Accepted: 01/25/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To report on our experience of patients who received infusion of bupivacaine with epinephrine after arthroscopic glenoid labral repair surgery and in whom glenohumeral joint chondrolysis subsequently developed, as well as to determine the incidence of such chondrolysis in our surgeons' patient populations. METHODS A retrospective chart review of 18 patients diagnosed with chondrolysis was carried out. All patients were from 2 experienced orthopaedic surgeons' practices. Details of their clinical course were obtained and summarized. These data were compared with all other arthroscopies completed by the 2 surgeons to determine the incidence of chondrolysis. RESULTS All 18 patients diagnosed with glenohumeral joint chondrolysis received postoperative infusion of bupivacaine with epinephrine through an intra-articular pain pump catheter (IAPPC). None of the patients received thermal energy as part of their procedure. None of the patients had evidence of glenohumeral joint infection, although an extensive workup was frequently undertaken. Clinically, patients presented with a stiff, painful shoulder. Examination showed decreased range of motion of the affected shoulder. Radiographs and magnetic resonance imaging showed joint space narrowing, as well as subchondral sclerosis and cyst formation. Of the 18 patients, 14 have since undergone repeat arthroscopic procedures, and 5 have received a humeral head-resurfacing operation. Within the same time period, there were 113 arthroscopies, with 45 pain pumps used. Chondrolysis developed in 16 of 32 patients with high-flow IAPPCs and 2 of 12 patients with low-flow IAPPCs (1 patient's IAPPC flow rate was not documented). CONCLUSIONS Although we cannot establish a causal link, the development of glenohumeral chondrolysis may be related to the intra-articular infusion of bupivacaine with epinephrine postoperatively. We thus caution against the use of IAPPCs. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- S Lance Anderson
- Division of Orthopaedic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | | |
Collapse
|
25
|
Yang HK, Park KS, Lee KB, Yoon TR. An unusual case of chondrolysis of the hip following excision of a torn acetabular labrum. Arch Orthop Trauma Surg 2010; 130:65-70. [PMID: 19238411 DOI: 10.1007/s00402-009-0837-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 11/25/2022]
Abstract
Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.
Collapse
|
26
|
Slabaugh MA, Friel NA, Cole BJ. Rapid chondrolysis of the knee after anterior cruciate ligament reconstruction: a case report. J Bone Joint Surg Am 2010; 92:186-9. [PMID: 20048111 DOI: 10.2106/jbjs.i.00120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark A Slabaugh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA
| | | | | |
Collapse
|
27
|
Böttcher P, Krastel D, Hierholzer J, Westphalen K, Florian S, Hildebrandt G, Vera G, Oechtering G. Percutaneous cementoplasty in the palliative, multimodal treatment of primary bone tumors of the distal aspect of the radius in four dogs. Vet Surg 2009; 38:888-901. [PMID: 19781033 DOI: 10.1111/j.1532-950x.2009.00596.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To (1) evaluate the analgesic effect of percutaneous cementoplasty (PC) in dogs with primary bone tumor (PBT) of the distal aspect of the radius and (2) evaluate the impact on the course of disease by adding PC to a palliative, multimodal treatment protocol in these dogs. STUDY DESIGN Prospective pilot study. ANIMALS Dogs (n=4) with PBT of the distal aspect of the radius. METHODS Tumor lesions were filled percutaneously with polymethylmethacrylate under fluoroscopic guidance. Pamidronate was administered once in a week before PC. Radiotherapy and chemotherapy were initiated 2 and 6 weeks after PC, respectively. Force plate analysis was performed immediately before 2, and 6 weeks after PC. Survival time was defined from PC to euthanasia. RESULTS Two dogs had a significant increase in peak vertical force 2 weeks after PC (P=.043) and remained free of lameness for 18 and 20 weeks, respectively. One dog had an acute relapse after an initially lame-free period of 10 days. The remaining dog failed to improve (P=.686). Three dogs developed at least 2 complications including transient worsening of the lameness after PC, cement leakage, wound infection and suspected thromboembolism in combination with cough and anemia. Median survival was 4.8 months (range, 1-5.7 months). CONCLUSIONS PC in combination with pamidronate significantly improved lameness in 2 dogs; however, PC is not risk-free. Deep wound infection, intraarticular cement leakage, and venous thrombosis were the main complications. CLINICAL RELEVANCE PC might be a useful addition to established palliative, multimodal treatment protocols in dogs with PBT; however, because of the complications encountered PC warrants further study before routine use can be considered.
Collapse
Affiliation(s)
- Peter Böttcher
- Department of Small Animal Medicine, University of Leipzig, An den Tierkliniken 23, Leipzig, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Chu CR, Izzo NJ, Coyle CH, Papas NE, Logar A. The in vitro effects of bupivacaine on articular chondrocytes. ACTA ACUST UNITED AC 2008; 90:814-20. [PMID: 18539679 DOI: 10.1302/0301-620x.90b6.20079] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have studied the effects of bupivacaine on human and bovine articular chondrocytes in vitro. Time-lapse confocal microscopy of human articular chondrocytes showed > 95% cellular death after exposure to 0.5% bupivacaine for 30 minutes. Human and bovine chondrocytes exposed to 0.25% bupivacaine had a time-dependent reduction in viability, with longer exposure times resulting in higher cytotoxicity. Cellular death continued even after removal of 0.25% bupivacaine. After exposure to 0.25% bupivacaine for 15 minutes, flow cytometry showed bovine chondrocyte viability to be 41% of saline control after seven days. After exposure to 0.125% bupivacaine for up to 60 minutes, the viability of both bovine and human chondrocytes was similar to that of control groups. These data show that prolonged exposure 0.5% and 0.25% bupivacaine solutions are potentially chondrotoxic.
Collapse
Affiliation(s)
- C R Chu
- Cartilage Restoration Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, School of Medicine, 3471 Fifth Ave, Suite 911, Pittsburgh, Pennsylvania 15213, USA.
| | | | | | | | | |
Collapse
|
30
|
Sanders TG, Zlatkin MB, Paruchuri NB, Higgins RW. Chondrolysis of the Glenohumeral Joint After Arthroscopy: Findings on Radiography and Low-Field-Strength MRI. AJR Am J Roentgenol 2007; 188:1094-8. [PMID: 17377053 DOI: 10.2214/ajr.05.1477] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this report is to describe the clinical and imaging findings of chondrolysis of the glenohumeral joint. CONCLUSION In the appropriate clinical setting, both radiographs and MR images of the shoulder can be used to establish the diagnosis of chondrolysis of the glenohumeral joint.
Collapse
Affiliation(s)
- Timothy G Sanders
- National Musculoskeletal Imaging, 1930 N Commerce Pkwy., Suite 5, Weston, FL 33326, USA.
| | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Robert Yarbrough
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | | |
Collapse
|
32
|
Abstract
A 21-year-old West Point cadet presented to our institution with a history of chronic left lateral ankle instability. The initial injury occurred 5 years earlier. Physical examination results and stress radiographs were consistent with lateral instability. The patient underwent an ankle arthroscopy and lateral ankle ligament reconstruction. Arthroscopic findings included moderate synovitis, grade II anterolateral chondrosis, and an anterior talar osteophyte. The patient had an uneventful postoperative course and returned to activity. Eleven months after surgery he presented with increased left ankle pain. On physical examination he had a stable ankle, but radiographs revealed marked loss of ankle joint space. Significant diffuse fraying and thinning of the articular cartilage noted on repeat arthroscopy were consistent with chondrolysis.
Collapse
Affiliation(s)
- John A Bojescul
- Orthopaedic Surgery Service, Keller Army Community Hospital, West Point, New York, USA
| | | | | |
Collapse
|
33
|
Petty DH, Jazrawi LM, Estrada LS, Andrews JR. Glenohumeral chondrolysis after shoulder arthroscopy: case reports and review of the literature. Am J Sports Med 2004; 32:509-15. [PMID: 14977682 DOI: 10.1177/0363546503262176] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Damon H Petty
- Petty Orthopaedics and Sports Medicine, Nashville, Tennessee, USA.
| | | | | | | |
Collapse
|
34
|
Widlus DM. Cementoplasty—Percutaneous Bone Stabilization. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|