RESUMO
Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.
Assuntos
Artroplastia de Quadril , Fraturas Ósseas , Prótese de Quadril , Próteses Articulares Metal-Metal , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Fraturas Ósseas/etiologia , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Próteses Articulares Metal-Metal/efeitos adversos , Metais , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , ReoperaçãoRESUMO
Total hip arthroplasty is one of the most common and successful orthopaedic procedures performed worldwide. Uncemented modular acetabular components and highly cross-linked polyethylene liners are the implants of choice for most arthroplasty surgeons. However, despite their well-known benefits, highly cross-linked polyethylene liners are not without complications, such as rim fracture, rupture and dissociation. We report three patients with gait instability and radiographic subluxation due to highly cross-linked polyethylene liner failures evidenced during stage one revision surgery. The three patients were symptoms free, with no new instability episodes, and the radiographs showed no evidence of implant loosening at the most recent follow-up. Although it is a rare complication, these three cases highlight the importance of suspecting and evaluating highly cross-linked polyethylene liner failures in patients referred for gait instability with no history of previous trauma.
Assuntos
Artroplastia de Quadril , Marcha , Prótese de Quadril , Falha de Prótese , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de PróteseRESUMO
CASE: We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. CONCLUSION: Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Diagnóstico Tardio , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico , Reoperação/métodos , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Idoso , Feminino , HumanosRESUMO
AIMS: The Corail stem has good long-term results. After four years of using this stem, we have detected a small group of patients who have presented with symptomatic metaphyseal debonding. The aim of this study was to quantify the incidence of this complication, to delineate the characteristics of patients presenting with this complication and to compare these patients with asymptomatic controls to determine any important predisposing factors. PATIENTS AND METHODS: Of 855 Corail collarless cementless stems implanted for osteoarthritis, 18 presented with symptomatic metaphyseal debonding. A control group of 74 randomly selected patients was assembled. Clinical and radiological parameters were measured and a logistic regression model was created to evaluate factors associated with metaphyseal debonding. RESULTS: The prevalence of this complication was 2.1% in our series. In the multivariable model, the presence of a Dorr B-type proximal femur was associated with metaphyseal debonding (odds ratio (OR) 10.73, 95% confidence interval (CI) 2.31 to 49.97, p = 0.002), as was a body mass index > 25 kg/m2 (OR 6.85, 95% CI 1.06 to 44.28, p = 0.04). Smaller stems and the use of a polyethylene acetabular liner appeared to be protective when compared with metal and ceramic setting hard-on-hard bearings. CONCLUSION: We have described an uncommon but important mode of failure of the Corail stem. Surgeons should be aware of this phenomenon; overweight patients with Dorr B-type femurs and in whom hard bearings are used appear to be particularly at risk. Cite this article: Bone Joint J 2017;99-B:1435-41.
Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Falha de Prótese/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Se presenta un estudio correlacional entre la conducta asertiva y la autoeficacia para la prevención de Enfermedades de Transmisión Sexual (ETS), en estudiantes de educación media. Para cumplir con los objetivos de la investigación se midieron y correlacionaron las variables; asertividad y autoeficacia para la prevención de ETS con la Escala validada de Autoeficacia para la prevención del SIDA en adolescentes (SEA 27) de López-Rosales, F. (2001) y el Cuestionario de Asertividad de De Gambrill, E.D. y Richey, C.A (1975). Los datos fueron procesados con el paquete estadístico SPSS. Se concluye que no existe correlación significativa en cuanto a la hipótesis especifica, al nivel de p<0.05, entre las variables de estudio, aceptando la hipótesis nula planteada.