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Hiyama K, Takakuwa T, Yamaguchi R, Mochizuki T. Stemless total shoulder arthroplasty for multiple epiphyseal dysplasia in a 52-year-old patient: a case report. JSES Int 2024; 8:126-131. [PMID: 38312288 PMCID: PMC10837698 DOI: 10.1016/j.jseint.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Kanehiro Hiyama
- Department of Orthopedic Surgery, Shoulder Center, Tokyo KITA Medical Center, Tokyo, Japan
| | - Takuya Takakuwa
- Department of Orthopedic Surgery, Shoulder Center, Tokyo KITA Medical Center, Tokyo, Japan
| | - Reiko Yamaguchi
- Department of Orthopedic Surgery, Shoulder Center, Tokyo KITA Medical Center, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopedic Surgery, Shoulder Center, Tokyo KITA Medical Center, Tokyo, Japan
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Chang YY, Lee CC, Lin SC, Kuo KN, Chang JF, Wu KW, Wang TM. The favorable outcome of Bernese periacetabular osteotomy for the hip osteoarthritis in multiple epiphyseal dysplasia. Orphanet J Rare Dis 2023; 18:340. [PMID: 37904148 PMCID: PMC10614309 DOI: 10.1186/s13023-023-02920-1] [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: 08/31/2022] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Multiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as the third to the fourth decade. Currently, there is no consensus on the prevention of the progressive hip osteoarthritis secondary to MED. The Bernese periacetabular osteotomy (PAO) is a joint-preserving surgery to reshape acetabulum and extend femoral head coverage. However, there is no documentary evidence for the effect of the procedure on MED hips. PATIENTS AND METHODS We analyzed the preliminary outcomes following the Bernese PAO in 6 MED hips. The average age at the time of surgery was 14.3 years (range from 11.4 to 17.2 years). For our study interest of time efficiency, radiographic parameters were analyzed preoperatively and 1 year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery. RESULTS The mean follow-up time was 1.7 years. The mean lateral center-edge angle increased from 3.8° to 47.1° (p = 0.02), anterior center-edge angle increased from 7.3° to 35.1° (p = 0.02), and acetabulum index decreased from 27.8° to 14.6° (p = 0.04). The femoral head coverage ratio increased from 66.8% to 100% (p = 0.02). The post-operative anteroposterior pelvic radiograph demonstrated all preoperative broken Shenton lines were reversed. The mean HHS improved from 67.3 to 86.7 (p = 0.05). CONCLUSION Bernese PAO is a feasible treatment for hip disorders in MED patients. It reshapes acetabular and femoral morphology efficiently. In our study, the preliminary results showed the procedure not only improved radiographic outcomes but also hip function.
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Affiliation(s)
- Yao-Yuan Chang
- Departments of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 100, Taiwan
| | - Chia-Che Lee
- Departments of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 100, Taiwan
| | - Sheng-Chieh Lin
- Department of Orthopaedic Surgery, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Ken N Kuo
- Departments of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 100, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, 110, Taiwan
| | - Jia-Feng Chang
- Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, 237, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, 110, Taiwan
| | - Kuan-Wen Wu
- Departments of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 100, Taiwan.
| | - Ting-Ming Wang
- Departments of Orthopedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 100, Taiwan.
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Matsushita M, Mishima K, Kamiya Y, Haga N, Fujiwara S, Ozono K, Kubota T, Kitaoka T, Imagama S, Kitoh H. Health-related Quality of Life in Adult Patients with Multiple Epiphyseal Dysplasia and Spondyloepiphyseal Dysplasia. Prog Rehabil Med 2021; 6:20210048. [PMID: 34909512 PMCID: PMC8640375 DOI: 10.2490/prm.20210048] [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: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: Multiple epiphyseal dysplasia (MED) and spondyloepiphyseal dysplasia (SED) are skeletal
dysplasias associated with premature osteoarthritis and short stature. Patients with SED
often have spinal and ocular problems. Few reports have focused on the health-related
quality of life (HRQoL) of patients with skeletal dysplasias associated with premature
osteoarthritis. The purpose of this study was to evaluate the HRQoL of adult patients
with MED and SED. Methods: Questionnaires covering demographics, medical history (cataract, retinal detachment,
and osteoarthritis), surgical history (osteotomy and arthroplasty), and the Short
Form-36 (SF-36) health survey were sent to all patients with MED and SED with medical
records at the investigators’ institutions. Among the 27 patients who completed the
questionnaire, patients aged 20 years or older were included in this cohort. Results: The subjects were 18 affected individuals. The physical component summary score (PCS)
was significantly lower in the MED and SED groups than in the normal population and
tended to deteriorate with age. Conversely, there was a positive correlation between the
mental component summary score and age. The role/social component summary score was not
correlated with age. MED patients with osteoarthritis had a low PCS. PCS was
particularly low in two SED patients with a medical history of cataract, whereas there
was no association with a history of retinal detachment or osteoarthritis. Conclusions: The physical domain of HRQoL in MED and SED patients significantly deteriorated at a
young age. Appropriate medical management of these skeletal dysplasias is required not
only for orthopedic functions but also for ocular problems.
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Affiliation(s)
- Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasunari Kamiya
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Japan.,Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia? J Pediatr Orthop 2021; 41:e135-e140. [PMID: 33165262 DOI: 10.1097/bpo.0000000000001708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are congenital skeletal disorders characterized by irregular epiphyses, mild or severe short stature and early-onset osteoarthritis which frequently affect the hips. The current study evaluates the long-term results of the Chiari osteotomy in MED and PSACH patients. METHODS Twenty patients (14 MED and 6 PSACH) were retrospectively included. Clinical assessment used the Postel Merle d'Aubigné (PMA) score and the Hip disability and Osteoarthritis Outcome Score (HOOS). Risser index, Sharp angle, acetabular depth index, center-edge angle, Tönnis angle, and femoral head coverage were measured on the preoperative radiographs and at last follow-up. The Treble index, which identifies the hip at risk in MED patients, was also determined. Stulberg classification (grades I to V) was used to evaluate the risk of osteoarthritis in the mature hips.Statistical analyses determined differences between preoperative and postoperative data. The Kaplan Meier method was used to calculate the survival rate of the operated hips using total hip arthroplasty as the endpoint. RESULTS Thirty-three hips which underwent a Chiari osteotomy were reviewed. The average follow-up was 20.1 years. The PMA scores were significantly better at last follow-up than preoperatively. All radiographic parameters significantly improved. Moreover, the Sharp angle, center-edge angle, and femoral head coverage improved to a normal value at hip maturity. All of the operated hips had a Treble index of type I. At hip maturity, a majority of hip were aspherical congruent (Stulberg grades of III and IV). The survival rate of the operated hips was 80.7% at 24 years postoperative. CONCLUSIONS The Chiari osteotomy is a satisfying solution for severe symptomatic hip lesions in MED and PSACH patients. At long-term follow-up, this procedure lessens pain and improves hip function, which delays total hip arthroplasty indication. LEVEL OF EVIDENCE Level IV.
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Patel H, Cichos KH, Moon AS, McGwin G, Ponce BA, Ghanem ES. Patients with musculoskeletal dysplasia undergoing total joint arthroplasty are at increased risk of surgical site Infection. Orthop Traumatol Surg Res 2019; 105:1297-1301. [PMID: 31542311 DOI: 10.1016/j.otsr.2019.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/19/2019] [Accepted: 06/05/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Musculoskeletal dysplasias (MSD) are inherited conditions of abnormal cartilage and bone development and remodeling which include, amongst others, multiple epiphyseal dysplasia (MED), spondyloepiphyseal dysplasia (SED), achondroplasia, and hypochondroplasia. The aim of this study was to compare patient characteristics and in-hospital complications between MSD and non-MSD patients undergoing total joint arthroplasty (TJA). HYPOTHESIS MSD patients undergoing TJA are at increased risk of in-hospital post-operative complications and mortality compared to non-MSD patients. MATERIALS AND METHODS The Nationwide Inpatient Sample (NIS) from the years 2005 to 2014 was used for this retrospective cohort study. International Classification of Diseases, Clinical Modifications (ICD-9-CM) procedure codes identified primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures and were used to separate MSD and non-MSD patients. Patients with trauma or malignancy as primary diagnoses, non-elective procedures, revision procedures, and concurrent bilateral surgeries were excluded. Patients were compared using linear regression or multivariate logistic regression analysis to control for confounders. All statistical analyses were performed taking into account the NIS sampling scheme and associated sampling weights. RESULTS A total of 1,255 patients comprised the MSD group and 8,027,181 patients the non-MSD group. MSD patients were younger than non-MSD patients (50.9 vs. 65.8 years, p<0.001), with less comorbidities including: hypertension (40.2% vs. 64.5%, p<0.001), coronary artery disease (5.5% vs. 12.9%, p<0.001), diabetes mellitus (9.4% vs. 19.0%, p<0.001), and hypothyroidism (7.8% vs. 14.7%, p=0.002). MSD patients had higher risks of surgical site infection (0.8% vs. 0.2%; OR, 4.16; 95% CI, 1.03-16.75; p=0.044), and perioperative hemorrhage (2.1% vs. 0.7%; OR, 3.20; 95% CI, 1.32-7.76; p=0.010). DISCUSSION MSD patients undergoing TJA were younger with less co-morbidity compared to non-MSD patients, and had no significant difference in overall perioperative medical and surgical complication rates. However, they are at increased risk for surgical site infection and perioperative hemorrhage possibly due to the anatomical complexity encountered. LEVEL OF EVIDENCE III, Retrospective Cohort.
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Affiliation(s)
- Harshadkumar Patel
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US
| | - Kyle H Cichos
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US
| | - Andrew S Moon
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US; Tufts University School of Medicine, Boston, MA, USA
| | - Gerald McGwin
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US
| | - Brent A Ponce
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US
| | - Elie S Ghanem
- University of Alabama at Birmingham Hospital, Department of Orthopaedic Surgery, 1313 13(th) St S, Birmingham, AL, 35205, US.
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Wyles CC, Panos JA, Houdek MT, Trousdale RT, Berry DJ, Taunton MJ. Total Hip Arthroplasty Reduces Pain and Improves Function in Patients With Spondyloepiphyseal Dysplasia: A Long-Term Outcome Study of 50 Cases. J Arthroplasty 2019; 34:517-521. [PMID: 30528131 PMCID: PMC6786491 DOI: 10.1016/j.arth.2018.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/08/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Spondyloepiphyseal dysplasia (SED) is rare genetic condition which leads to skeletal and joint deformities that can predispose patients to degenerative joint disease. There are limited reports on the results of total hip arthroplasty (THA) in this patient population. The purpose of this study is to review clinical and radiographic outcomes of THA performed in patients with SED at one institution. METHODS Among 43,917 patients undergoing primary THA from 1970 to 2015, we identified 50 THAs performed in 29 patients with SED; 21 patients underwent bilateral THA (none simultaneous). There were 16 females and 13 males; mean age, body mass index, and height were 39 years, 28.7 kg/m2, and 145 cm, respectively. All patients were able to ambulate prior to the THA. Mean follow-up was 11 years (range 2-38). RESULTS Mean implant survival for primary THA in SED patients at the 5, 10, and 20-year time points was 96%, 85%, and 55%, respectively. Thirteen patients required revision THA, most commonly for polyethylene wear (n = 6) and aseptic loosening (n = 5), and 4 additional patients underwent nonrevision reoperations. Prior to surgery, 90% of patients had severe or moderate pain, which was reduced to 8% of patients postoperatively (P < .001). Mean Harris Hip Score improved from 47 to 87 (P < .001). Prior to surgery, 64% of patients required gait aids, which reduced to 34% postoperatively (P < .001). CONCLUSION THA provided significant pain reduction and improvement in function, with a majority of patients ambulating independently following the procedure. There was a high incidence of complications following THA in patients with SED, most commonly secondary to polyethylene wear and osteolysis from conventional polyethylene and historical implants. LEVEL OF EVIDENCE Level IV, Therapy.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Vanlommel J, Vanlommel L, Molenaers B, Simon JP. Hybrid total hip arthroplasty for multiple epiphyseal dysplasia. Orthop Traumatol Surg Res 2018; 104:301-305. [PMID: 29274861 DOI: 10.1016/j.otsr.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/13/2017] [Accepted: 11/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Multiple Ephiphyseal Dysplasia (MED) is a rare autosomal dominant skeletal dysplasia that causes deformation of the epiphysis of the involved joints. The hips are invariably affected and symptoms due to incapacitating early onset degenerative hip disease often begin between the second and fourth decade of life. Literature regarding the clinical and radiographical outcomes after total hip arthroplasty in this young population are very scarce. Hypothesis in patients with multiple epiphyseal dysplasia and early onset degenerative hip disease, hybrid total hip arthroplasty is a safe and reliable procedure. PATIENTS AND METHODS We followed 10 hybrid total hip arthroplasties in 6 patients with respect to the early and medium term complications. The average age at surgery was 32 years old (17 to 41). All stems were cemented polished straight tapered stems, all cups were porous coated uncemented cups. The mean duration of follow-up was 10.3 (7-14, SD2.8) years. Clinical outcomes were measured using the Charnley modification of the Merle d'Aubigné-Postel grading system and VAS-scores. RESULTS No early complications and no revisions occurred and patients significantly improved for pain, function and mobility. The Charnley, Merle d'Aubigné and Postel hip scores significantly improved from 9.6 points pre-operatively (range: 8-11 points) to 17 points (range: 16-18 points) and the VAS-score significantly improved after surgery from respectively 7 at rest and 8.5 during activity preoperatively to 1 at rest and 1.5 during activity postoperatively. Radiographic evaluation showed no cases of radiolucency around the cemented femoral components. No migration or subsidence of the components was noted. With regard to the acetabular component, osteolysis was noted in 4 hips, but serial radiographs showed no progression or migration of the component and the patients were completely pain free. CONCLUSION Hybrid total hip arthroplasty is a viable treatment option in multiple epiphyseal dysplasia patients, with excellent mid-term clinical and radiographical outcomes. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- J Vanlommel
- Orthoclinic, AZ Sint Lucas Brugge, Sint Lucaslaan 29, 8310, Brugge Belgium.
| | - L Vanlommel
- UZ Pellenberg, department of Orthopaedics, Weligerveld 1, Leuven, Belgium
| | - B Molenaers
- UZ Pellenberg, department of Orthopaedics, Weligerveld 1, Leuven, Belgium
| | - J-P Simon
- UZ Pellenberg, department of Orthopaedics, Weligerveld 1, Leuven, Belgium
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Abstract
We reviewed the radiologic and clinical outcomes of hip joints affected by multiple epiphyseal dysplasia in 40 patients. The average patient age was 9.6 years. All patients were followed up for an average of 7.2 years. No patient underwent surgical treatment. The variances of the center-edge angle and femoral head coverage had the greatest tendency to increase with conservative treatment and follow-up (P=0.011 and 0.015, respectively). The acetabular angle and the acetabular depth index at the first visit and the latest follow-up were statistically significantly different (P=0.046 and 0.027, respectively). According to the Stulberg classification, the severity of hip deformity became less severe with age, but this was not statistically significant (P=0.090). Larger improvements in Harris hip scores were identified after conservative treatment (P=0.003). Favorable midterm outcomes were obtained for the treatment of hip deformity in multiple epiphyseal dysplasia patients by conservative treatment.
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Abstract
Multiple epiphyseal dysplasia is a genotypically and phenotypically heterogeneous disorder affecting the epiphysis of long bones. Inheritance may be autosomal dominant or autosomal recessive. Autosomal dominant variants include mutations of the collagen oligomeric matrix protein, collagen type IX α-1, collagen type IX α-2, collagen type IX α-3, and matrilin-3 genes. The autosomal recessive variant is caused by a mutation of the sulfate transporter gene SLC26A2. These mutations cause disorganized endochondral ossification of the epiphysis, ultimately leading to destruction of the articular cartilage. Patients typically present in childhood, but some may not present until early adulthood. A presumptive diagnosis can be made with clinical history, physical examination, detailed family history, and radiographic findings. Definitive diagnosis requires genetic testing. Treatment is based on the age of the patient, the amount of limb deformity, the level of joint destruction, and the needs of the patient. Children can greatly benefit from limb realignment procedures, and adults can have excellent outcomes with joint arthroplasty.
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Drexler M, Dwyer T, Marmor M, Abolghasemian M, Chakravertty R, Chechik O, Cameron HU. Nineteen year results of THA using modular 9 mm S-ROM femoral component in patients with small femoral canals. J Arthroplasty 2013; 28:1667-70. [PMID: 23618752 DOI: 10.1016/j.arth.2013.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/26/2013] [Accepted: 03/14/2013] [Indexed: 02/01/2023] Open
Abstract
A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5 cm (130-170.5 cm), mean weight was 63 kg (39-90 kg), and mean follow-up period was 19 years (range, 12-23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.
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Affiliation(s)
- Michael Drexler
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kosashvili Y, Raz G, Backstein D, Lulu OB, Gross AE, Safir O. Fresh-stored osteochondral allografts for the treatment of femoral head defects: surgical technique and preliminary results. INTERNATIONAL ORTHOPAEDICS 2013; 37:1001-6. [PMID: 23553116 DOI: 10.1007/s00264-013-1868-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/09/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to present the preliminary clinical and radiographic outcomes of the treatment of femoral head osteochondral defects in eight consecutive symptomatic patients with fresh-stored osteochondral allografts via a trochanteric osteotomy. METHODS This study included all consecutive patients treated in our department between 2008 and 2010 for worsening pain and mechanical symptoms of femoral head osteochondral defects. Each patient had preoperative routine hip radiographs and a preoperative magnetic resonance imaging study that determined and recorded the defect size and femoral head diameters. Allograft donors were identified through the Multiple Organ Retrieval and Exchange program (Ontario, Canada). RESULTS The osteochondral defects were secondary to osteochondritis dissecans in four patients, avascular necrosis in three and femoral head fracture without dislocation in one. The patients' average age at surgery was 23.7 (range 17-42), and the average follow-up was 41 months (range 24-54). Follow-up included clinical and radiographic examinations at standard intervals. The average Harris hip scores improved from 57.7 (range 50-65) points preoperatively to 83.9 (range 72-94) points at latest follow-up. Five patients had good-to-excellent clinical outcomes, and one had a fair outcome. One patient was converted to a total hip arthroplasty due to progression of arthritis. Another patient's graft subsided and he underwent a successful repeat transplantation. An additional patient required the removal of the screws transfixing her trochanter due to persistent irritation. CONCLUSIONS These findings indicate that fresh-stored osteochondral allograft transplantation using a trochanteric slide and surgical dislocation is a viable treatment option for femoral head defects in young patients.
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Affiliation(s)
- Yona Kosashvili
- Orthopaedic Department, Division of Arthroplasty, Rabin Medical Center, Beilinson Campus (Affiliated to Sackler Faculty of Medicine), Tel Aviv University, 39 Zabotinsky Street, Petach Tikva, Israel.
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