The management of severe acetabular bone defects remains challengin due to extensive bone loss and poor soft tissue quality during revision total hip arthroplasty (rTHA). The aim of this study was to assess clinical and radiological outcomes of the use of dual mobility components (DMC) cemented into a newly implanted porous tantalum (PT) acetabular shell during acetabular rTHA. Patients who underwent cementation of a DMC into a newly implanted PT cup between 2014 and 2020 were included. Bone defects were classified according to the Paprosky classification. The primary outcome was to determine the reintervention-free survival rate. The secondary outcome was clinical and radiographic assessment at last follow-up. Thirty-six patients (36 hips), with an average age of 67.9 years (range, 46–90) were included. Paprosky type III defects (61.1%) were more common than type II defects (38.9%), with type IIIa (36.1%) and IIIb (25.0%) predominating. Median follow-up was 67.3 months (range; 17–109). The dislocation rate was 8.3% (n = 3). Four (11.1%) of 36 hips underwent acetabular component revision: 2 (5.5%) for infections, 1 (2.7%) for aseptic loosening, and 1 (2.7%) for dislocation. Cup survival rate was 89.08% (CI 69.54% to 96.38%) at 60 months. The Harris hip score (HHS) improved from 31.8 ± 12.0 to 87.0 ± 14.2 points (p < 0.001). The vertical and horizontal position of the hip center of rotation (COR) improved from 19.4 ± 14.9 mm to 3.8 ± 3.4 mm and from 12.4 ± 9.9 mm to 3.8 ± 3.5 mm, respectively (both p < 0.001). Limb length discrepancy improved from − 7.8 ± 20.6 mm to -1.7 ± 5.6 mm (p = 0.056). DMCs cemented into PT shells could be considered an effective management of severe acetabular bone defects without pelvic discontinuity providing excellent clinical and radiographic results in the mid-term.
M. Loppini, V. Di Matteo, Alberto Bulgarelli et al.· Archives of Orthopaedic and...· 0 citations
Background/Objectives: Posterolateral meniscocapsular detachment represents a potentially underrecognized component of knee trauma in patients with anterior cruciate ligament (ACL) injury. Altered rotational kinematics in ACL-deficient knees may increase stress on posterolateral corner structures. Although an association between ACL tears and posterolateral abnormalities has been reported, the true diagnostic performance of magnetic resonance imaging (MRI) for these lesions remains incompletely defined. This study aimed to evaluate the diagnostic accuracy of MRI for posterolateral meniscocapsular detachment in patients with confirmed ACL injury, to describe associated meniscal tears, and to assess the association between lateral tibial plateau bone marrow edema, age, and sex with the presence of detachment. Methods: In this retrospective study, 117 knee MRI examinations (1.5 T and 3 T) of patients with native ACL rupture or ACL graft failure were reviewed. Two readers independently assessed posterolateral meniscocapsular detachment. Ramp lesions, other meniscal tears and lateral compartment bone marrow edema were evaluated in consensus. Arthroscopy served as the reference standard. Diagnostic performance and inter-observer agreement were calculated. Detachment was considered present only when both readers independently identified the lesion. Results: MRI demonstrated high specificity (90.8%; 95% CI: 83.7–95.5%) for posterolateral meniscocapsular detachment, and promising sensitivity (87.5%; 95% CI: 47.3–99.7%) based on a small number of confirmed cases (n = 8); this estimate should be interpreted with caution given the wide confidence interval. One arthroscopically confirmed lesion was missed, and false-positive findings were limited. MRI also showed good diagnostic performance for ramp lesions and other associated meniscal tears, assessed as secondary endpoints. Lateral tibial plateau bone marrow edema, age, and sex were not significantly associated with detachment. Conclusions: Routine MRI shows high specificity and promising, although preliminary, sensitivity for detecting posterolateral meniscocapsular detachment in ACL-injured knees; given the small number of confirmed cases, this estimate warrants confirmation in larger cohorts. Careful multiplanar assessment and detailed anatomical knowledge are essential to optimize detection. Accurate preoperative MRI characterization may help guide surgical planning and reduce the risk of missed posterolateral meniscocapsular pathology at arthroscopy.
T. Bonanzinga, Elena Tosi, A. Favaro et al.· Diagnostics· 0 citations
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