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Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.

van Hove RP, de Jong T, Nolte PA - Clin Orthop Surg (2014)

Bottom Line: Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts.A case of cementless total knee arthroplasty in a patient with ADO I is presented.Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands.

ABSTRACT
Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

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Postoperative radiograph of the right hip. Anteroposterior view of the right hip 1 day after resection arthroplasty. The lower arrow indicates the false route in the proximal femur, and the upper arrow indicates the acetabular fracture.
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Figure 4: Postoperative radiograph of the right hip. Anteroposterior view of the right hip 1 day after resection arthroplasty. The lower arrow indicates the false route in the proximal femur, and the upper arrow indicates the acetabular fracture.

Mentions: The patient presented with progressive pain and functional loss of the right hip 3 years later, which was 4 months after closed reduction of an anterior dislocation of the right hip. Hip flexion was limited to 80° with only 10° of rotation. Radiographs of the pelvis showed a dense bone structure, narrowing of the joint space, and slight dysplastic features of both hip joints. She was scheduled for a cementless total hip arthroplasty (THA). A craniocaudal acetabular fracture arose during surgery while preparing the acetabulum for the prosthesis. We prepared the femur while awaiting the osteosynthetic material. Entrance to the medullary canal was extremely difficult, and a false route occurred on the lateral side of the femoral canal. Considering both problems, we saw no possibility of achieving a stable THA and decided to conduct a resection arthroplasty (Fig. 4). She is without pain 1 year after surgery, and mainly uses a wheelchair. She is able to walk a few steps behind a walking aid. This situation is accepted by the patient and her caretaker. The patient and her caretaker were informed and agreed that data concerning the case could be submitted for publication.


Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.

van Hove RP, de Jong T, Nolte PA - Clin Orthop Surg (2014)

Postoperative radiograph of the right hip. Anteroposterior view of the right hip 1 day after resection arthroplasty. The lower arrow indicates the false route in the proximal femur, and the upper arrow indicates the acetabular fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233231&req=5

Figure 4: Postoperative radiograph of the right hip. Anteroposterior view of the right hip 1 day after resection arthroplasty. The lower arrow indicates the false route in the proximal femur, and the upper arrow indicates the acetabular fracture.
Mentions: The patient presented with progressive pain and functional loss of the right hip 3 years later, which was 4 months after closed reduction of an anterior dislocation of the right hip. Hip flexion was limited to 80° with only 10° of rotation. Radiographs of the pelvis showed a dense bone structure, narrowing of the joint space, and slight dysplastic features of both hip joints. She was scheduled for a cementless total hip arthroplasty (THA). A craniocaudal acetabular fracture arose during surgery while preparing the acetabulum for the prosthesis. We prepared the femur while awaiting the osteosynthetic material. Entrance to the medullary canal was extremely difficult, and a false route occurred on the lateral side of the femoral canal. Considering both problems, we saw no possibility of achieving a stable THA and decided to conduct a resection arthroplasty (Fig. 4). She is without pain 1 year after surgery, and mainly uses a wheelchair. She is able to walk a few steps behind a walking aid. This situation is accepted by the patient and her caretaker. The patient and her caretaker were informed and agreed that data concerning the case could be submitted for publication.

Bottom Line: Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts.A case of cementless total knee arthroplasty in a patient with ADO I is presented.Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands.

ABSTRACT
Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

Show MeSH
Related in: MedlinePlus