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Pellegrini MJ, Mombello F, Cortes A, Chaparro F, Ortiz C, Carcuro G. Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148172. [PMID: 36741679 PMCID: PMC9893082 DOI: 10.1177/24730114221148172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023). Conclusion Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence Level IV, prospective case series.
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Affiliation(s)
- Manuel J. Pellegrini
- Hospital Clinico Universidad de Chile, Santiago, Chile,Clinica Universidad de Los Andes, Santiago, Chile,Manuel J. Pellegrini, MD, Facultad de Medicina, Departamento de Traumatología, Clinica Universidad de los Andes, Av. Plaza 2501, Santiago 7620157, Chile.
| | | | - Aaron Cortes
- Clinica Universidad de Los Andes, Santiago, Chile
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Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Failure and progression to total hip arthroplasty among the treatments for femoral head osteonecrosis: a Bayesian network meta-analysis. Br Med Bull 2021; 138:112-125. [PMID: 34009284 DOI: 10.1093/bmb/ldab006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) often leads to secondary osteoarthritis and total hip arthroplasty. SOURCE OF DATA Recent published literatures. AREAS OF AGREEMENT There has been increasing focus on the early intervention in ONFH patients to preserve the native hip articulation, reduce pain and improve function. AREAS OF CONTROVERSY Efficacy of surgical strategies for ONFH is debated. Several clinical studies showed controversial results, and the best treatment has not yet been clarified. GROWING POINTS To provide an overview over current treatment options for ONFH compares their failure rates and conversion to total hip arthroplasty (THA) rates. AREAS TIMELY FOR DEVELOPING RESEARCH Core decompression (CD) augmented with autologous bone grafting plus the implantation of bone marrow concentrate can decrease the rate of failure and progression to THA rates compared to CD alone.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, 52064 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi SA, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, ST4 7QB Stoke on Trent, UK
| | - Alice Baroncini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, 52064 Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, 52064 Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, 52064 Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, 68167 Mannheim, Germany
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[Partial hip resurfacing-a critical analysis]. DER ORTHOPADE 2021; 50:119-123. [PMID: 33346866 DOI: 10.1007/s00132-020-04056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Localized cartilage lesions or osteochondral defect areas of the hip joint often affect young patients with an active professional and personal live. There are multiple causes of these defect zones, but they determine the therapeutic options to some extent. THERAPEUTIC OPTIONS In addition to the domain of joint-preserving, implant-free hip surgery, so-called mini-prostheses or partial implants represent another treatment strategy prior to the application of a total hip arthroplasty (THA). In the following, partial joint resurfacing implants (e. g., HemiCAP®, Arthrosurface, Franklin, MA, USA) are presented and results from the literature are cited. The described procedure is not widely offered, especially in Germany, because most indications are congruent with those for implantation of a THA, which is an established technique. Consequently, the results from the literature are based on case series with inferior validity compared to the studies and registry data of the THA and accordingly have to be scrutinized in a more critical way. Total surface replacement (hip resurfacing, e.g., Birmingham hip replacement, BHR, Smith and Nephew, Memphis, TN, USA) distinguish from partial surface replacement. On the one hand the BHR shows parallels with regard to the femoral surface reconstruction, but on the other hand due to the obligatory replacement of the acetabular side of the joint it meets conditions of THA, which can therefore play at best an intermediate role between a stem-anchored THA and a partial replacement.
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van Buul GM, Thompson E, Lutchumun R, O'Toole G, O'Donnell T. Partial Articular Resurfacing Secondary to Pediatric Hip Chondroblastoma Curettage with a 5-YearFollow-Up: A Case Report. JBJS Case Connect 2021; 11:e20.00297. [PMID: 33464000 DOI: 10.2106/jbjs.cc.20.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE This report describes a case of pediatric femoral head chondroblastoma, which was initially treated by minimally invasive curettage. At the 18-month follow-up, a subsequent osteochondral defect occurred, which was treated with a partial articular resurfacing system. At 5.5 years follow-up, he was symptom-free with minor degenerative x-ray changes. CONCLUSION We describe a technique of focal anatomic hip resurfacing using the HemiCAP system in a pediatric chondroblastoma patient who presented with an osteochondral defect after primary curettage. This approach yielded good short-term to midterm results and is a potential alternative to total hip arthroplasty in young patients.
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Affiliation(s)
- G M van Buul
- Orthopaedic Department, Beacon Hospital, Dublin, Ireland
| | - E Thompson
- Orthopaedic Department, St. Vincent's University Hospital, Dublin, Ireland
| | - R Lutchumun
- Orthopaedic Department, Beacon Hospital, Dublin, Ireland
| | - G O'Toole
- Orthopaedic Department, Beacon Hospital, Dublin, Ireland.,Orthopaedic Department, St. Vincent's University Hospital, Dublin, Ireland
| | - T O'Donnell
- Orthopaedic Department, Beacon Hospital, Dublin, Ireland
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Meng X, Zhang W, Yuan Z, Chen J, Lyu Z, Wang Y. A partial hemi-resurfacing preliminary study of a novel magnetic resonance imaging compatible polyetheretherketone mini-prosthesis for focal osteochondral defects. J Orthop Translat 2021; 26:67-73. [PMID: 33437625 PMCID: PMC7773958 DOI: 10.1016/j.jot.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of partial articular resurfacing surgery with a mini-implant has been gradually increasing; the implant is mainly made of cobalt-chromium metal material, and cartilage changes cannot be monitored after implantation. Thus, we aimed to develop a novel local articular resurfacing polyetheretherketone (PEEK) mini-implant and investigate its feasibility for postoperative magnetic resonance imaging (MRI) monitoring of implant location, bone changes, and cartilage degeneration without artefacts. METHODS Nine skeletally mature female standardised goats were used and divided into the sham, PEEK, and cobalt-chromium-molybdenum alloy (Co-Cr-Mo) groups. The animals underwent local articular resurfacing operation with Co-Cr-Mo alloy (Co-Cr-Mo group) and PEEK (PEEK group) mini-implants. X-ray, computed tomography, and MRI examinations were performed at 12 weeks postoperatively. The sham group underwent a similar surgical procedure to expose the femoral head but without implantation. Gross necropsy and surface topography measurement of the articular cartilage of the acetabulum were performed after sacrificing the animals. Imaging artefacts and opposing cartilage degeneration in the acetabulum were also examined. RESULTS Cartilage damage occurred in both the Co-Cr-Mo and PEEK groups, and the damaged cartilage area was markedly larger in the Co-Cr-Mo group than in the PEEK group, as assessed by gross necropsy and histological staining. The mean surface roughness of the opposing cartilage was approximately 65.3, 117.4, and 188.4 μm at 12 weeks in the sham, PEEK, and Co-Cr-Mo groups, respectively. The Co-Cr-Mo mini-implant was visualised on radiographs, but computed tomography and MR images were markedly affected by artefacts, whereas the opposing cartilage and surrounding tissue were clear on MR images in the PEEK group. Opposing cartilage damage and subchondral bone marrow oedema could be detected by MRI in the PEEK group. CONCLUSIONS The PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects with less cartilage damage. It is feasible to postoperatively monitor the PEEK implant location, surrounding bone changes, and opposing cartilage degeneration by MRI without artefacts. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE The use of MRI to monitor changes in the opposing cartilage after prosthesis implantation has not been widely applied because MR images are generally affected by artefacts generated by the metal prosthesis. This study revealed that the PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects, and it is feasible to monitor the PEEK implant location, surrounding bone changes, and opposing cartilage damage/degeneration by MRI without artefacts postoperatively.
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Affiliation(s)
- Xiangchao Meng
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuocheng Lyu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Pak H, Ri SG, Jang MG, Kim SJ. Endoscopic observation finding in the core decompression procedure of osteonecrosis of femoral head and effect of additional treatments. INTERNATIONAL ORTHOPAEDICS 2020; 45:95-99. [PMID: 33245375 DOI: 10.1007/s00264-020-04863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To observe necrotic findings of the femoral head through the endoscopic examination when performing the decompression procedure widely used in the treatment of osteonecrosis of femoral head. To assess the efficacy of injection of bone marrow aspirated from the iliac crest and new vascularized bone graft into the core of femoral head based on the endoscopic findings. METHODS The first stage of osteonecrosis of femoral head based on ARCO classification includes 23, second stage 36, and third stage eight femoral heads. Bone marrow transplantations have been performed in 49 hip joints and new vascularized bone grafts in 18 hip joints. RESULTS The endoscopic findings of osteonecrosis of femoral heads are varied, and they can be divided into five categories. The average time in core decompression and bone marrow injection was 15 minutes, and the average time of new pedicled bone grafts was 65 minutes (45-90 minutes). The efficacy of bone marrow injection was 93.88%, and the efficacy of vascularized bone graft was 94.44% when performed based on the endoscopic findings. CONCLUSION It is possible to increase the treatment efficacy of the osteonecrosis of the femoral head when appropriate additional treatments are applied based on endoscopic findings in the decompression procedures of pre-collapse osteonecrosis of the femoral head.
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Affiliation(s)
- Hyon Pak
- Department of Microsurgery and Plastic Surgery, HyeSan Medical College, HyeSan, Korea.
| | - Song Gun Ri
- Department of Microsurgery and Plastic Surgery, Pyongyang University of Medical Sciences, Pyongyang, Korea
| | - Myong Guk Jang
- Department of Microsurgery and Plastic Surgery, Pyongyang University of Medical Sciences, Pyongyang, Korea
| | - Sung Jae Kim
- Pyongyang University of Medical Sciences, Pyongyang, Korea
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Vuurberg G, Reilingh ML, van Bergen CJ, van Eekeren IC, Gerards RM, van Dijk CN. Metal Resurfacing Inlay Implant for Osteochondral Talar Defects After Failed Previous Surgery: A Midterm Prospective Follow-up Study. Am J Sports Med 2018; 46:1685-1692. [PMID: 29624081 PMCID: PMC5985591 DOI: 10.1177/0363546518764916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. PURPOSE To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014. The primary outcome measure was implant survival, as measured by reoperation rate. Secondary outcome measures were numeric rating scales for pain at rest and during walking, running, and stair climbing; the Foot and Ankle Outcome Score (FAOS); the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale; the 36-Item Short Form Health Survey (SF-36); return to work and sports; and radiographic evaluation. RESULTS This study included 38 patients with a mean age of 39 years (SD, ±13 years) and a mean follow-up of 5.1 years (SD, ±1.5 years). Two patients (5%) underwent revision surgery by means of an ankle arthrodesis (2 and 6 years postoperatively). In 8 patients, computed tomography scanning was conducted to assess postoperative complaints. These scans showed impression of the tibial plafond (n = 4), a small tibial cyst (<2.5 mm; n = 1), and cyst formation around the implant screw (n = 4). A total of 21 reoperations were performed, including medial malleolar screw removal (n = 12), arthroscopic removal of bony anterior impingement (n = 7), and calcaneal realignment osteotomy (n = 2). All secondary outcome measures improved significantly, apart from pain at rest, the FAOS symptoms subscale, and the SF-36 mental component scale. The mean time for return to sport was 4.1 months (SD, ±3 months), and 77% of patients resumed sporting activities postoperatively. Only 1 patient did not return to work postoperatively. Radiographs at final follow-up showed cyst formation (n = 2), subchondral periprosthetic radiolucency (n = 2), and non-preexisting joint space narrowing (n = 2). CONCLUSION This study shows that the metal implant is an effective technique when assessed at midterm follow-up for OCDs of the medial talar dome after failed previous surgery.
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands,Gwendolyn Vuurberg, Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands ()
| | - Mikel L. Reilingh
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | | | - Inge C.M. van Eekeren
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - Rogier M. Gerards
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - C. Niek van Dijk
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
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Liao Y, Su R, Zhang P, Yuan B, Li L. Cortisol inhibits mTOR signaling in avascular necrosis of the femoral head. J Orthop Surg Res 2017; 12:154. [PMID: 29047405 PMCID: PMC5648506 DOI: 10.1186/s13018-017-0656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ANFH is a major health problem, to which long lasting and definitive treatments are lacking. The aim of this study is to study RNA alterations attributed to cortisol-induced ANFH. METHODS Rat models were stratified into three groups: in vitro group (n = 20) for molecular biological assays, control group (n = 3), and ANFH group induced using lipopolysaccharide and dexamethasone (n = 3). Bone marrow-derived endothelial progenitor cells (BM-EPCs) were extracted from the rats. An RNA expression array was performed on BM-EPCs, and enriched genes were subject to pathway analysis. In vitro studies following findings of array results were also performed using the isolated BM-EPCs. RESULTS Significant alterations in mammalian target of rapamycin (mTOR) and HIF signaling pathways were identified in BM-EPCs of ANFH. By applying cortisol and dexamethasone to BM-EPCs, significant changes in mTOR and HIF elements were identified. The alteration of HIF pathways appeared to be downstream of mTOR signaling. Glucocorticoid receptor (GR) expression was related to glucocorticoid-dependent mRNA expression of mTOR/HIF genes. mTOR-dependent angiogenesis but not anabolism was the target of GR in ANFH. Inhibition of mTOR signaling also induced apoptosis of BM-EPCs via CHOP-dependent DR5 induction in response to GR stimulation. CONCLUSION Decreased mTOR signaling in response to GR stimulation leading to downregulated HIF pathway as well as increased apoptosis could be the pathophysiology.
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Affiliation(s)
- Yun Liao
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.,Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Rui Su
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Ping Zhang
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Bo Yuan
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Ling Li
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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The outcome of the partial resurfacing arthroplasty of the hip shows high numbers of failures and conversion to total arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:2001-2008. [PMID: 28819826 DOI: 10.1007/s00264-017-3594-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Local cartilage and bony defects, which are too large for joint preserving cartilage treatment are difficult to treat. The implantation of a mini-resurfacing implant (Hemicap®, 2med, Hamburg, Germany) may be a possible alternative treatment for these patients. This partial replacement fills the defect and restores a smooth and continuous articular surface. The aim of this study was to determine short- to midterm results of the treatment of local cartilage defects of the femoral head using the Hemicap®. METHODS Since 04/2011 16 patients with osteonecrosis of the femoral head greater ARCO stage II or local femoral cartilage lesions (< 35 mm) were treated with the implantation of the Hemicap® implant. A clinical and radiological follow-up was conducted. RESULTS The clinical results showed a significant improvement of the function and pain of the hip according to the Harris Hip Score from 56 (±14) preoperative to 77 (±15) post-operative 25 months after implantation of the Hemicap®. In the meantime, in four patients the Hemicap® had to be converted to a total hip arthroplasty due to loosening, progredience of the osteonecrosis or degeneration of the acetabulum. CONCLUSIONS The implantation of the mini-resurfacing implant Hemicap® seemed to be an alternative treatment for local cartilage defects of the femoral head to postpone the implantation of a total hip arthroplasty. However, the clinical outcome seems to be inferior to total hip arthroplasty. Furthermore, due to a high rate of conversion to total hip arthroplasty (25%) the application of this implant is questionable. If the implant is considered as a treatment option at least patient selection and enlightenment for this treatment with the high risk of failure and progression of osteoarthritis is very important.
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Ettinger S, Stukenborg-Colsman C, Waizy H, Becher C, Yao D, Claassen L, Noll Y, Plaass C. Results of HemiCAP ® Implantation as a Salvage Procedure for Osteochondral Lesions of the Talus. J Foot Ankle Surg 2017. [PMID: 28633778 DOI: 10.1053/j.jfas.2017.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. The aim of the present study was to examine the clinical outcomes after HemiCAP® implantation for OCDs of the medial talar dome after failed previous surgery. Our retrospective study included 11 patients, who had undergone surgery from June 2009 to September 2012 for an OCD of the medial talar dome and received a HemiCAP® on the talus after failed previous surgery for OCD. The data were acquired using patients' medical records and standardized questionnaires, including the Foot and Ankle Outcome Score (FAOS), University of California at Los Angeles (UCLA) activity score, EQ-5D, numerical rating scale (NRS), and Short-Form 36-item Health Survey (SF-36). Using these scores, the possibility of returning to work and sports was determined. Any complications and the need for revision surgery were recorded. One patient refused to participate in the study, leaving 10 patients for evaluation. The mean age was 47.64 ± 10.97 years. The mean follow-up period was 43.5 ± 35.51 months. The FAOS and SF-36 subscale scores and the EQ-5D and UCLA activity scores did not improve significantly (p < .05). The mean postoperative pain score on the NRS improved significantly from 6.6 ± 1.77 preoperatively to 5.1 ± 2.02 postoperatively (p < .05). A greater body mass index led to worse postoperative outcomes with higher scores on the pain-NRS and less satisfaction (p < .05). Ten revisions for ongoing pain were performed in 7 patients (70.0%) within a mean of 28.4 ± 13.35 months of the initial procedure, and 6 patients (60%) indicated they would undergo surgery again. The results of the present study have shown that implantation of the HemiCAP® as a salvage procedure for OCDs of the talus is challenging and does not consistently lead to good clinical results. Also, overweight patients appear to have an increased risk of postoperative dissatisfaction and persistent ankle pain.
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Affiliation(s)
- Sarah Ettinger
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.
| | | | - Hazibullah Waizy
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hessing-Stiftung, Augsburg, Germany
| | | | - Daiwei Yao
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Leif Claassen
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Yvonne Noll
- Assistant, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Plaass
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
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Scaglione M, Fabbri L, Celli F, Casella F, Guido G. Hip replacement in femoral head osteonecrosis: current concepts. ACTA ACUST UNITED AC 2016; 12:51-4. [PMID: 27134633 DOI: 10.11138/ccmbm/2015.12.3s.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient's factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.
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Affiliation(s)
| | - Luca Fabbri
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | - Fabio Celli
- Orthopedic Clinic, University of Pisa, Pisa, Italy
| | | | - Giulio Guido
- Orthopedic Clinic, University of Pisa, Pisa, Italy
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Bilge O, Doral MN, Miniaci A. Focal anatomic resurfacing implantation for bilateral humeral and femoral heads' avascular necrosis in a patient with Hodgkin's lymphoma and literature review. Int J Surg Case Rep 2015; 17:128-32. [PMID: 26624502 PMCID: PMC4701814 DOI: 10.1016/j.ijscr.2015.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/22/2015] [Accepted: 10/25/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The femoral and humeral heads are among the most common sites of osteonecrosis. The aims of this case report was to report three years' results for sequential treatment of bilateral, concomitant involvement of humeral and femoral heads with focal anatomic resurfacing implantation in a single patient with Hodgkin's lymphoma and to review the relevant literature, which is relatively scarce. PRESENTATION OF CASE We present a 48-year-old male patient with concomitant, bilateral femoral and humeral head avascular necrosis. He was diagnosed as Hodgkin's lymphoma in 1984. He had bilateral groin and shoulder pain, lasting for three years and aggravated by joint motions. Radiological evaluations demonstrated bilateral focal osteonecrosis of femoral heads and humeral heads, respectively. Despite conservative treatment, he did not obtain any symptomatic relief. Following the common decision, he was treated with sequential implantations with the HemiCAP(®) device for both bilateral pathologies, by a single surgeon and standard surgical approaches. Neither intraoperative nor postoperative complication was encountered. After the follow-up period of 36 months after the last surgery, he was symptomless and with normal range of motion for all four joints. DISCUSSION The bilateral, concomitant involvement of humeral and femoral head in the setting of avascular necrosis is relatively rare. Moreover, the optimal treatment method at earlier stages, in young patients has not been established yet. CONCLUSION This study is the first report to present the three-years' clinical result of a single, relevant case, who was treated with sequential focal anatomic resurfacing implantations (HemiCAP(®)) in four aforementioned joints.
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Affiliation(s)
- Onur Bilge
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080 Konya, Turkey.
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, 06230 Ankara, Turkey.
| | - Anthony Miniaci
- Cleveland Clinic Sports Health Center, 5555 Transportation Blvd, Garfield Heights, OH 44125, USA.
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