Bone defects are a challenge to any and in fact every orthopedic surgeon, be they as a consequence of trauma, peri-implant bone loss as is the case in revision surgery or, more often than not, in tumors of the bone. These defects are in most cases difficult to reconstruct, but even more so in the case when they are located around the major joints of the lower limb, i.e. the hip and the knee. We focus in this article on acetabular bone defects as well as on defects around the knee (distal femur and proximal tibia). We present implant possibilities and modern means of reconstructing the bone defect using augments. We also present three representative cases from our Clinic, to further exemplify the discussed concepts. We present our opinions on reconstructing bone defects after tumor and revision surgery in the hip and knee and we draw conclusions.
The use of osteosynthesis materials in orthopedics is fundamental in the surgical management of patients presenting with various pathologies of the locomotor system, in most cases trauma, but also malign and benign tumors. The risk that these materials could have in inducing malignant transformation of benign tumors or in the onset of primary malignant tumors, was rarely studied. On the one hand, primary malignant tumors of the locomotor system are much less frequent than other kind of neoplasms (for example Ewing sarcoma has an incidence of 1-3 cases / 1.000.000 people / year, ostosarcoma has an incidence of 2 cases / 1.000.000 people / year). On the other hand, usually there is a time window of several years, different from one case to another, from the moment of action of the etiopathogenic factor to the moment of revealing the presence of a neoplastic disease. Based on our clinical practice on a few clinical cases, we intend to study more thoroughly the etiology of primary bone malignant tumors in general and the role of the osteosynthesys materials in this matter especially.
The purpose of this paper was to evaluate the necesity of associating a lateral extraarticular tenodesis in patients that will undergo an anterior cruciate ligament reconstruction or revision and to briefly describe the surgical procedure. Multiple lateral extraarticular tenodesis techniques were described and also graft selection and fixation types are also important. In conclusion acute ACL tears with grade 3+ pivot shift can be succesfully treated by combined ACL reconstruction and LEAT association.
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