Caso Clínico Dr. Fabián Landa - ACARO
Transcript of Caso Clínico Dr. Fabián Landa - ACARO
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Caso Clínico
Dr. Fabián Landa Dr . Nicolás Guzmán
Servicio de Ortopedia y Traumatología Sanatorio del Norte
Tucumán
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Historia clínica
Masculino.
39 años.
Derivado de otro servicio con antecedente de fractura de acetábulo (osteosíntesis por vía posterior ) en Noviembre 2011.
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A los 3 meses subluxación y necrosis de cabeza femoral.
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ATC no cementada con migración protésica
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Revisión con ATC cementada con nueva migración y luxación
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Proyección Alar
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Proyección Obturatriz
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• Dolor – deformidad – impotencia funcional.
• Rx ( AP – Alar – Obturatriz –inlet –outlet ).
• Tac con artefactos técnicos .
• Estudios para infección negativos.
DEFECTO ACETABULAR SEGMENTARIO POSTEROSUPERIOR
1° Consulta en el servicio
Tipo I – A ( AAOS )
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Posibilidades Terapéuticas
• Retiro de osteosíntesis
• Sí
• No
• Reconstrucción acetabular:
• Injerto Óseo
• Material trabecular
• Cajas acetabulares
• Combinaciones
• Revisión acetabular:
• No cementada.
• Cementada.
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• Componente femoral:
• Recambio de cabeza
• Sí
• No
• Aumentar longitud de cuello
• Sí
• No
• Revisión del tallo
• Sí
• No
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Retiro de osteosíntesis y prótesis
Reconstrucción acetabular con injertos de banco
Revisión protésica completa
TRATAMIENTO PROPUESTO
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Edge-Loading Wear
• Wear of a highly cross-linked polyethylene liner associated with metallic deposition on a ceramic femoral head. Della Valle AG1, Doty S, Gradl G, Labissiere A, Nestor BJ. J Arthroplasty. 2004 Jun;19(4):532-6.
• Does metal transfer affect the tribological behaviour of femoral heads? Roughness and phase transformation analyses on retrieved zirconia and Biolox® Delta composites. Affatato S, Ruggiero A, De Mattia JS, Taddei P. Composites Part B Engineering · February 2016 as DOI:10.1016/j.compositesb.2016.02.020
• Surface roughness of ceramic femoral heads after in vivo transfer of metal: correlation to polyethylene wear. Kim YH, Ritchie A, Hardaker C. J Bone Joint Surg Am. 2005 Mar;87(3):577-82.
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Reconstrucción Acetabular
• Della Valle CJ, Berger RA, Rosenberg AG, Galante JO: Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res 2004;(420):96-100.
• Sporer SM, Paprosky WG: The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplasty 2006; 21(6 suppl 2):83-86.
• Van Kleunen JP, Lee GC, Lementowski PW, Nelson CL, Garino JP: Acetabular revisions using trabecular metal cups and augments. J Arthroplasty 2009;24(6suppl):64-68.
• Sporer, S.M.; O’Rourke, M.; Chong, P.; Paprosky, W.G. The use of structural distal femoral allografts for acetabular reconstruction. Surgical technique. J. Bone Jt. Surg. Am. 2006, 88, 92–99.
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15/10/16
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15/10/16
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