Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. / Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España.

BACKGROUND AND OBJECTIVE: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. METHOD: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain.

BACKGROUND AND OBJECTIVE: In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. MATERIAL AND METHOD: An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results.

INTRODUCTION: Enhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery. MATERIAL AND METHODS: A multidisciplinary group created the programme and the patient school (preoperative consultations where the patients' surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D). RESULTS: One hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively. CONCLUSIONS: The ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.

A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months.

BACKGROUND: This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. METHODS: We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7-66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27-72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. RESULTS: Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. CONCLUSION: Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.

The knee prosthesis constraint dilemma: Biomechanical comparison between varus-valgus constrained implants and rotating hinge prosthesis. A cadaver study.

The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique - the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with p > .1; the mean error for tibial rotation was 0.21°. Tibial rotation in the RHK was significantly greater than in the CCK (5.25° vs. 2.28°, respectively), p < .05. We have shown that RHK permit greater tibial rotation, being closer to physiological values than CCKs. Inertial sensors have been validated as an effective and accurate method of measuring knee movement. The clinical significance: RHK appears to represent a lower constriction degree than CCK systems.

Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months.

BACKGROUND: This study aims to analyse the clinical results of ultrasound-guided surgery for the decompression of the tibial nerve, including its distal medial and lateral branches, to treat tarsal tunnel syndrome. These structures are the complete flexor retinaculum and the deep fascia of the abductor hallucis muscle, including individualised release of the medial and lateral plantar nerve tunnels. METHOD: This is a retrospective review of 81 patients (36 men and 45 women) with an average age of 41 years old (32-62) and an average clinical course of 31 months (8-96) compatible with idiopathic tarsal tunnel syndrome, who underwent ultrasound-guided decompression of the proximal and distal tarsal tunnel between February 2015 and November 2017 (both months included), with a minimum follow-up of 18 months. RESULTS: Based on the Takakura et al. scale for the 81 patients, 76.54% obtained excellent results, 13.58% good results, and 9.87% poor results. The patients with the longest course of symptoms displayed the worst results. CONCLUSION: Although 9% of patients did not improve, ultrasound-guided tarsal tunnel release might be a viable alternative to conventional open approaches.

Biarticular total femoral spacer for complete bone loss in periprosthetic joint infection. A technical modification. / Espaciador femoral total biarticulado para el tratamiento de la infección periprotésica de cadera y rodilla con pérdida completa de hueso. Modificación técnica.

BACKGROUND: The management of complete bone defects in hip and knee periprosthetic infection is still a real surgical challenge. MATERIAL AND METHODS: We present a technical modification for performing a biarticular total femoral spacer with a femoral nail without the need to approach the proximal tibia. RESULTS: Three patients were operated with this technique. There was no intraoperative complication. The infection was resolved in all patients operated at final follow-up. All patients improved their previous functional situation and could walk with different aids. CONCLUSIONS: This technical modification is an alternative for cases where it is necessary to resect the complete femur, but it is not necessary to approach the tibia.

New method for antibiotic release from bone cement (polymethylmethacrylate): Redefining boundaries. / Nuevo método de liberación de antibióticos del cemento óseo (polimetilmetacrilato): redefiniendo los límites.

INTRODUCTION: The increasing antimicrobial resistance is promoting the addition of antibiotics with high antistaphylococcal activity to polymethylmethacrylate (PMMA), for use in cement spacers in periprosthetic joint infection. Linezolid and levofloxacin have already been used in in-vitro studies, however, rifampicin has been shown to have a deleterious effect on the mechanical properties of PMMA, because it inhibits PMMA polymerization. The objective of our study was to isolate the rifampicin during the polymerization process using microencapsulation techniques, in order to obtain a PMMA suitable for manufacturing bone cement spacers. MATERIAL AND METHOD: Microcapsules of rifampicin were synthesized with alginate and PHBV, using Rifaldin®. The concentration levels of rifampicin were studied by UV-visible spectrophotometry. Compression, hardness and setting time tests were performed with CMW®1 cement samples alone, with non-encapsulated rifampicin and with alginate or PHBV microcapsules. RESULTS: The production yield, efficiency and microencapsulation yield were greater with alginate (P = .0001). The cement with microcapsules demonstrated greater resistance to compression than the cement with rifampicin (91.26±5.13, 91.35±6.29 and 74.04±3.57 MPa in alginate, PHBV and rifampicin, respectively) (P = .0001). The setting time reduced, and the hardness curve of the cement with alginate microcapsules was similar to that of the control. DISCUSSION AND CONCLUSIONS: Microencapsulation with alginate is an appropriate technique for introducing rifampicin into PMMA, preserving compression properties and setting time. This could allow intraoperative manufacturing of bone cement spacers that release rifampicin for the treatment of periprosthetic joint infection.

Moldes individualizados para alineación de la artroplastía primaria de rodilla / Individualized molds for alignment of primary knee arthroplasty

Introducción: Los sistemas de bloque de corte específicos (BCE) se han presentado como una interesante medida para obtener una correcta alineación en la artroplastía de rodilla, aunque se desconoce cuál de todos los métodos existentes para realizar la planificación es el adecuado. Material y métodos: Se ha diseñado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineación. Se analizaron parámetros radiográficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusión, tiempo quirúrgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadísticamente significativas entre los dos sistemas de alineamiento específicos y el sistema convencional (p > 0.05), aunque se objetivó una mayor precisión con estos sistemas, siendo discretamente superior en el sistema Signature. También se observó un menor tiempo quirúrgico en los pacientes intervenidos con los BCE, ligeramente inferior en los intervenidos con el sistema Visionaire (p > 0.05). Conclusiones: Los nuevos sistemas BCE pueden ser útiles para mejorar la alineación en la artroplastía de rodilla así como disminuir el tiempo quirúrgico. A la espera de series mayores que corroboren estos datos, los autores recomiendan estos sistemas en aquellos casos en los que los sistemas convencionales no sean adecuados.

Introduction: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. Material and methods: A prospective study was designed to compare two PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. Results: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). Conclusions: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

[Individualized molds for alignment of primary knee arthroplasty]. / Moldes individualizados para alineación de la artroplastía primaria de rodilla.

INTRODUCTION: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. MATERIAL AND METHODS: A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. RESULTS: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). CONCLUSIONS: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

[Influence of the physiological medium on the mechanical properties of bone cement: can current studies be extrapolated?]. / Influencia del medio fisiológico sobre las propiedades mecánicas del cemento óseo. ¿Son los estudios actuales extrapolables?

PURPOSE: The use of bone cement is widespread in orthopaedic surgery. Most of the mechanical tests are performed in dry medium, making it difficult to extrapolate the results. The objective of this study is to assess if the mechanical properties of polymethylmethacrylate (PMMA), obtained in previous reports, are still present in a liquid medium. MATERIAL AND METHOD: An experimental study was designed with antibiotic (vancomycin) loaded PMMA. Four groups were defined according to the medium (dry or liquid) and the pre-conditioning in liquid medium (one week or one month). Wear and flexural strength tests were performed according to ASTM and ISO standards. Volumetric wear, friction coefficient, tensile strength, and Young's modulus were analyzed. All samples were examined by scanning electron microscopy. RESULTS: The samples tested in liquid medium showed lower wear and flexural strength values (P<.05). The kind of wear was modified from abrasive to adhesive in those samples studied in liquid medium. The samples with a pre-conditioning time showed lower values of wear (P<.05). CONCLUSIONS: Caution is recommended when extrapolating the results of previous PMMA results. The different mechanical strength of the cement in a liquid medium, observed in saline medium, is much closer to the clinical situation.

[Bilateral avascular necrosis after resurfacing hip arthroplasty. A case report]. / Necrosis avascular bilateral tras artroplastía de cadera de recubrimiento. Reporte de un caso.

Resurfacing hip arthroplasty is an alternative to conventional arthroplasty and it is indicated in young and active patients. Good results and the prevention of complications stem from a meticulous surgical technique and proper patient selection. We present herein the case of a 43 year-old patient who, after undergoing bilateral hip replacement with resurfacing prostheses, sustained a non-simultaneous fracture of both femoral necks due to avascular necrosis. He was treated by placing a metaphyseal anchoring stem. Postoperative X-rays showed proper implant placement without femoral notching, with a discrete 7 degrees valgus alignment of the femoral component. Both passive and active mobility was painful. X-rays showed cervical fracture of the right femur. The femoral head was attached to the implant, with no metallosis nor loosening of the femoral or acetabular components, but the bone had a fragmented and friable appearance that histopathologically was defined as avascular necrosis. Femoral neck fracture is the main complication after resurfacing hip arthroplasty. The effect of other factors like bone necrosis due to cement is unknown.