Three-dimensional Planning and Virtual Radiographs in Revision Total Hip Arthroplasty for Instability

Abstract

Instability is one of the most challenging complications of total hip arthroplasty. The cause of instability is not always clear and treatment outcome is not always satisfactory. Treatment can be optimized by accurate identification of the cause of instability and precise surgical technique. In this case report, we illustrate the use of a three-dimensional (3-D) preoperative planner and virtual radiographic system to improve component position in revision total hip arthroplasty required because of recurrent dislocation. Using this technique, we identified common problems seen in patients with unstable hips after previous revision surgery including impingement, cup malpositioning, bone deficiency in the medial wall, and integrity of fixation screws. The computer-assisted system allowed preoperative planning with range of motion simulation and optimization of the acetabular cup position. The virtual radiographic system provided 3-D measurement of the cup position using a postoperative plane radiograph.

Usefulness of PET/CT for diagnosis of periosteal chondrosarcoma of the femur: A case report

“…In the treatment of this condition, wide resection is essential since the rates of recurrence and metastases are higher for patients treated with intralesional or marginal excisions than for patients treated with wide resection. Papagelopoulos et al (2) reported that the 5-year local recurrence-free survival rate was lower in patients treated with intralesional or marginal excisions (25%) than for patients treated with wide resections (93%). In addition, the 5-year metastasis-free survival rate was lower for patients who underwent intralesional or marginal excisions (50%) than for patients who were treated by wide resection (100%).…”

“…Periosteal chondrosarcoma is an extremely rare and low-grade malignant cartilaginous tumor arising from the external surface of bones (1), and it accounts for <2% of all chondrosarcomas (2). Wide resection is the only recommended treatment, as it minimizes the potential for recurrence and metastases (3–6).…”

Pediatric sarcomas occurring in adults

“…Similarly, periosteal osteosarcoma appears to arise from a somewhat deeper layer of periosteum and is associated with bowing of elevated periosteum more than frank cortical destruction, and more typically affects the tibia than other bones. Chemotherapy is usually not used for this diagnosis either, and surgical excision is the principal treatment modality [4,5]. However, patients with high-grade versions of either tumor should be considered for systemic chemotherapy either before or after resection of the primary lesion.…”

Fine‐needle aspiration biopsy diagnosis of costal juxtacortical chondrosarcoma presenting as an abdominal mass

“…Less extensive procedures increase the chance of local recurrence, which is associated with late metastasis and poor survival. 7,12 There is controversy about the radiosensitivity of these tumors. Chondrosarcoma has been traditionally regarded as a radioresistant tumor, and radiotherapy has mainly been used postoperatively for high-grade lesions.…”

“…They arise from the periosteum and usually are smaller than 2-3 cm, and have radiographic features of solid periosteal buttresses. 12 Although generally hypocellular, occasionally periosteal chondromas can be more cellular and show greater nuclear pleomorphism, and even binucleation. 4 Therefore, without radiological correlation such as size and location of the lesion, the cytological differentiation between these two entities may be virtually impossible in low grade tumors.…”