Background and purposeA decrease of 15% in femoral offset (FO) has been reported to generate a weakness of the abductor muscle, but this has not been directly linked to an alteration of gait. Our hypothesis was that this 15% decrease in FO may also generate a clinically detectable alteration in the gait.Patients and methodsWe performed a prospective comparative study on 28 patients who underwent total hip arthroplasty (THA) for unilateral primary osteoarthritis. The 3D hip anatomy was analyzed preoperatively and postoperatively. 3 groups were defined according to the alteration in FO following surgery: a minimum decrease of 15% (9 patients), restored (14), and a minimum increase of 15% (5). A gait analysis was performed at 1-year follow-up using an ambulatory device. Each limb was compared to the contralateral healthy limb.ResultsIn contrast to the “restored” group and the “increased” group, in the “decreased” group there was a statistically significant asymmetry between sides, with reduced range of motion and a lower maximal swing speed on the operated side.InterpretationA decrease in FO of 15% or more after THA leads to an alteration in the gait. We recommend 3-D preoperative planning because the FO may be underestimated by up to 20% on radiographs and it may therefore not be restored, with clinical consequences.
Cervical spondylotic myelopathy results from the synergistic action of static and dynamic factors, the latter of which play an important role. In some patients, IHIS on T2 images is only visible with the neck in flexion. That might explain why IHIS is first detected after surgery in some patients in whom MRI was obtained before surgery only in the neutral position. Dynamic MRI is useful to determine more accurately the number of levels where the spinal cord is compromised, and to better evaluate narrowing of the canal and IHIS. New information provided by flexion-extension MRI might change our strategy for CSM management.
IntroductionThe principal drawback of surgery for bony metastatic locations, particularly vertebral metastases (VM), is, for many surgeons, the relative frequency of complications due to the procedures themselves. We decided to verify whether this fear is well founded by determining the frequency of immediate and secondary complications of such surgery, and to look for causes or predisposing factors that might point to means for reducing the frequency of these complications. Materials and methodsWe carried out a retrospective study of 145 patients operated in our unit between 1982 and 1991 for vertebral metastasis of malignant tumours. The surgery was indicated to reduce pain, prevent onset or aggravation of neural deficits, and to improve the quality of life of the patients. Primary vertebral tumours were excluded from this series. Vertebral locations of haematological malignancies, which involve problems similar to those encountered in solid tumour metastases, were, on the other hand, included. EpidemiologyPrimary tumor (Table 1) The 145 patients operated were among 155 patients hospitalized between 1982 and 1991 in our unit, for secondary locations of malignant tumours. Among these 155 patients, the primary tumour had already been diagnosed in 103 patients at the time that one or more metastases were detected. Vertebral metastasis was the inaugural manifestation of cancer in the other 52 patients (33.5%).In the majority of cases in which the primary tumour was already known at diagnosis of vertebral metastasis, either breast cancer (n = 39, 37.8%), lung cancer (n = 13, 12.6%) or colon cancer (n = 8, 7.7%, all colic locations combined) was involved.Among the rarer locations were noted tumours of the kidney, prostate, uterus (neck or body), oesophagus and bladder. We classed the even rarer tumours into the category "others" (synoviosarcoma, neuroendocrine carcinoma, leiomyosarcoma, malignant melanoma, malignant fibrous histiocytoma, tumour of the pancreas, tumour of the pharynx), when they were already diagnosed at the time of discovery of VM. AbstractThe authors report their experience concerning complications of spinal metastasis surgery. The purpose of this study was to assess the frequency of such complications and analyse the factors influencing their occurrence. The records of 145 patients treated between 1982 and 1991 for metastatic disease of the spine were retrospectively reviewed for intra-and postoperative complications. Other factors such as radiation therapy, emergent nature of surgery, and neurologic deficits were analysed for potential correlations with the frequency of complications. Twentyseven (18.6%) patients developed postoperative complications. Wound dehiscence and infection (11%) were the most frequent complications. Statistical analysis showed a significant influence of three factors: preoperative radiation therapy, paraplegia before surgery, and surgery under emergency conditions. The rate of complications in this surgery is lower than might be expected and can be significantly reduced....
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