1
|
Machado V, San-Julián M. Risk factors for early osteoarthritis in tenosynovial giant cell tumour. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.003] [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
|
2
|
Xie P, Deng Y, Tan J, Wang M, Yang Y, Ouyang H, Huang W. The effect of rotational degree and routine activity on the risk of collapse in transtrochanteric rotational osteotomy for osteonecrosis of the femoral head-a finite element analysis. Med Biol Eng Comput 2020; 58:805-814. [PMID: 32016806 PMCID: PMC7156356 DOI: 10.1007/s11517-020-02137-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
To explore the mechanical mechanism and provide preoperative planning basis for transtrochanteric rotational osteotomy (TRO) procedure, a joint-preserving procedure for osteonecrosis of the femoral head. Eleven TRO finite element femurs with the most common types of necrosis were analyzed under multi-loading conditions. Thereafter, we made a comprehensive evaluation by considering the anatomy characters, daily activities, and risk indicators contain necrosis expansion trend, necrotic blood supply pressure, and the risk of fracture. The risk of fracture (ROF) is the lowest when standing on feet and increases gradually during normal walking and walking upstairs and downstairs. Compared with posterior rotation, rotating forward keeps more elements at low risk. Additionally, the correlation analysis shows it has a strong negative correlation (R2 = 0.834) with the average modulus of the roof. TRO finally decreased the stress and energy effectively. However, the stress and strain energy arise when rotated posteriorly less than 120°. The comprehensive evaluation observed that rotating forward 90°could reduce the total risks to 64%. TRO is an effective technique to prevent collapse. For the anterior and superior large necrosis, we recommend to rotate forward 60° to 90° (more efficient) or backward 180°. The methodology followed in this study could provide accurate and personalize preoperative planning. Graphical Abstract A proximal femur was reconstructed and modified using Mimics from a series of computed tomography. The models were meshed after solidified and performed different osteotomy, and then assigned material based on the Hounsfield Unit from CT images. Finally, 44 different TRO finite element femurs were analyzed under multi-loading conditions and evaluated comprehensively.
Collapse
Affiliation(s)
- Pusheng Xie
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Jinchuan Tan
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Mian Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
| | - Hanbin Ouyang
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Department of Anatomy, School of Basic Medicine Science, Guangdong Provincial Key laboratory of Medical Biomechanics, Southern Medical University, 1023 ShaTai Rd, Baiyun District, Guangzhou, 510515 People’s Republic of China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Southern Medical University, 1023 ShaTai Rd, Guangzhou, 510515 People’s Republic of China
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, 524002 People’s Republic of China
| |
Collapse
|
3
|
Machado V, San-Julián M. Risk factors for early osteoarthritis in tenosynovial giant cell tumour. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:199-205. [PMID: 31980414 DOI: 10.1016/j.recot.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Tenosynovial giant cell tumour (TGCT) is locally aggressive entity affecting young people (around 4th decade of life) and can cause joint destruction. It could be nodular or diffuse. These two varieties are histological and genetically similar, but present a different prognosis. The aim of this study is to identify risk factors for local recurrence and predisposing factors for the development of early osteoarthritis in patients with TGCT. MATERIAL AND METHODS We conducted a retrospective study of 35 patients with an anatomopathological diagnosis of TGCT in our Institution from 1991 to 2017. The mean follow-up was 8.2 years. Demographic variables, characteristics of the primary tumor and its evolution were collected to assess the risk factors for local recurrence and early osteoarthritis. RESULTS The diffuse type was identified as a risk factor for the development of osteoarthritis (p=0.01) and for local recurrence (p=0.015). Osteoarthritis was more frequent in the hip and ankle than in the knee (p=0.03). A difference of 16 months in the duration of symptoms prior to diagnosis between those who developed osteoarthritis and those who did not was observed (p=0.05). CONCLUSIONS The diffuse type is more aggressive than the nodular type; it is associated with a higher risk of osteoarthritis and local recurrence. The hip and ankle present a higher risk of osteoarthritis than other joints. The time of evolution of the symptoms before diagnosis and adequate treatment, negatively influences the development of osteoarthritis.
Collapse
Affiliation(s)
- V Machado
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - M San-Julián
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| |
Collapse
|
4
|
Nazal MR, Parsa A, Martin SD. Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy. Arthrosc Tech 2019; 8:e641-e646. [PMID: 31334023 PMCID: PMC6624174 DOI: 10.1016/j.eats.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/16/2019] [Indexed: 02/03/2023] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challenging due to difficulty obtaining the appropriate exposure. The purpose of this technical report is to describe a novel technique that allows for sound excision of PVNS during hip arthroscopy using a puncture capsulotomy. Full visualization throughout the central and peripheral compartments is key to achieving meticulous surgical excision and ablation, with careful attention to the medial and lateral synovial folds and gutters. It is important to avoid chondral injury by using a high outflow rate of irrigation to maintain a constant temperature, to ablate the blood supply of nodular lesions, and to not use a shaver as this may disseminate tumor cells. Multifactorial advancements in hip arthroscopy have permitted adequate visualization and exposure of PVNS lesions, making them amenable to arthroscopic synovectomy. Puncture capsulotomy does not require capsular closure, preserves the iliofemoral ligament, and minimizes exposure of extra-articular structures to the hip joint environment. Recurrence rates are lower in arthroscopic management compared with open management, at 7.7% and 17.8%, respectively.
Collapse
Affiliation(s)
- Mark R. Nazal
- Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
| | - Ali Parsa
- Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Address correspondence to Ali Parsa, M.D., Suite 400, 175 Cambridge St, Boston, MA, 02118, U.S.A.
| | - Scott D. Martin
- Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
| |
Collapse
|
5
|
Tanaka R, Yasunaga Y, Fujii J, Yamasaki T, Shoji T, Adachi N. Transtrochanteric rotational osteotomy for various hip disorders. J Orthop Sci 2019; 24:463-468. [PMID: 30554936 DOI: 10.1016/j.jos.2018.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/27/2018] [Accepted: 10/28/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Joint-preserving procedures should be considered as much as possible for hip disorders in pediatric and young patients. However, in patients with extensive osteonecrosis (ON) of the femoral head combined with severe collapse and advanced secondary osteoarthritis (OA), the optimal procedure has not been elucidated. This retrospective study aimed to investigate the postoperative outcomes of 11 patients who underwent transtrochanteric rotational osteotomy (TRO) alone or with a combination treatment for various hip disorders in young patients and to evaluate the usefulness of TRO. METHODS Eleven patients (11 hips) with a mean age at operation of 22 years were included. The mean follow-up duration was 9.4 years. Preoperative diagnosis was secondary OA in 6 patients (pigmented villonodular synovitis, 2; after rotational acetabular osteotomy, 1; pyogenic arthritis, 1; femoroacetabular impingement, 1; acetabular dysplasia, 1) and ON in 5 patients (slipped capital femoral epiphysis, 4; femoral neck fracture, 1). Combination treatment was performed in 2 patients with distraction arthroplasty and in 6 patients with intra-articular procedures (mosaicplasty, 1; drilling, 1; microfracture, 4; cam resection, 1). Clinical evaluation was performed by using the Merle d'Aubigne and Postel score (MDPS). Joint congruency and progression of osteoarthritic change in all cases, and progression of collapse in the ON patients were evaluated radiographically. RESULTS The mean MDPS improved from 10.3 to 14.2 in the OA patients and from 9.4 to 14.8 in the ON patients. The OA grade was maintained or improved in 10 hips (91%). Progressive collapse was prevented in all ON patients, and good remodeling was demonstrated. CONCLUSION Even in the highly degenerative cases, TRO enabled repair and prevention of the progression of OA. This procedure might be a useful salvage operation for treating secondary OA and ON of the hip even if the clinical condition is advanced, especially in young patients.
Collapse
Affiliation(s)
- Ryuji Tanaka
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan.
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan
| | - Jiro Fujii
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi Saijo, Higashi-Hiroshima, 739-0036, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
6
|
Xu C, Guo H, Bell KL, Kuo FC, Chen JY. Pigmented villonodular synovitis does not influence the outcome following cementless total hip arthroplasty using ceramic-on-ceramic articulation: a case-control study with middle-term follow-up. J Orthop Surg Res 2018; 13:294. [PMID: 30458820 PMCID: PMC6245816 DOI: 10.1186/s13018-018-0996-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/04/2018] [Indexed: 11/12/2022] Open
Abstract
Background Pigmented villonodular synovitis (PVNS) is a relatively rare, locally aggressive, and potentially recurrent synovial disease of large joints. The purpose of this study was to investigate (1) the disease recurrence rate and (2) the treatment outcomes including Harris hip scores, complications, and revision following cementless total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) articulation in patients with PVNS. Methods Twenty-two patients (14 females and 8 males) with histologically confirmed PVNS underwent cementless THA using CoC bearings between 2000 and 2013. Three patients with less than 5-year follow-up were excluded. The mean age was 35.2 years (range, 22–58 years) with a mean follow-up of 8.6 years (range, 6.9–10.8 years). A control group was matched in a 2:1 ratio with the PVNS group for age, sex, body mass index (BMI), year of surgery, and American Society of Anesthesiologists score (ASA). Postoperative outcome variables included disease recurrence, Harris Hip Scores (HHS) at the latest follow-up, complications (dislocation, squeaking, ceramic fracture), and any-cause revision. A Kaplan-Meier implant survivorship curve with 95% confidence interval (CI) of the two groups was generated. Results No recurrence of PVNS was noted in the follow-up period. The HSS in the PVNS group was 92.6 ± 5.5, which was similar to the control group (93.4 ± 4.6, p = 0.584) at the last follow-up visit. No patients sustained dislocation, osteolysis, or any ceramic fracture within the study duration. One patient in the PVNS group had a complication of squeaking, but did not require revision. Another patient in the PVNS group underwent revision surgery due to aseptic loosening. There was no significant difference in revision rates between the two groups (p = 1.000). The implant survivorship free of any revision was 90.0% (95% CI, 73.2% to 100%) in the PVNS group and 92.5% (95% CI, 82.6% to 100%) in the control group at 10 years (p = 0.99). Conclusions For young and active patients with end-stage PVNS of the hips, cementless THA using CoC bearing has similar functional outcome scores, a low complication rate, and similar implant survivorship compared to the control group.
Collapse
Affiliation(s)
- Chi Xu
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Heng Guo
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Orthopaedic Surgery, Beijing Mentougou District Hosptial, Beijing, China
| | - Kerri L Bell
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University, College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung, 833, Taiwan.
| | - Ji-Ying Chen
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
7
|
Open and Arthroscopic with Mini-Open Surgical Hip Approaches for Treatment of Pigmented Villonodular Synovitis and Concomitant Hip Pathology. Case Rep Orthop 2017; 2017:3716360. [PMID: 28326214 PMCID: PMC5343235 DOI: 10.1155/2017/3716360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022] Open
Abstract
Background. Pigmented villonodular synovitis (PVNS) is a rare benign tumor affecting large joints and prompts excision to prevent local destruction of the joint. The purpose of this case report is to describe two differing surgical approaches for management of PVNS of the hip in patients requiring concomitant treatment for additional hip pathology. Methods. This report discusses the presentation, clinical and radiographic findings, and operative management of two contrasting cases of PVNS of the hip. Case 1 describes a 31-year-old female with localized PVNS in addition to a labral tear treated with arthroscopic labral repair followed by tumor excision via a mini-open incision. Case 2 describes a 29-year-old male with more diffuse PVNS in addition to a cam deformity managed with open surgical dislocation of the hip, tumor excision, and restoration of the femoral head/neck junction. Results. This report demonstrates two cases of successful excision of PVNS of the hip in addition to addressing concomitant hip pathology in both cases. Conclusions. Open surgical dislocation of the hip or arthroscopic surgery with a mini-open incision may be used in appropriately selected patients to successfully excise PVNS lesions in addition to addressing concomitant hip pathology.
Collapse
|