[Translated article] Total knee arthroplasty is effective in patients with Parkinson's disease. Functional assessment and analysis of complications.

INTRODUCTION: Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA. METHODS: We retrospectively studied 31 patients with PD operated between 2014 and 2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the knee scoring system (KSS) and the visual analogue scale (VAS) for the functional evaluation. The modified Hoehn and Yahr scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed. RESULTS: The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (p<.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (p<.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only 5 were poorly satisfied. Seven patients suffered surgical complications, and 4 patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%. CONCLUSIONS: In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.

Total knee arthroplasty is effective in patients with Parkinson's disease. Functional assessment and analysis of complications. / La artroplastia total de rodilla en pacientes con enfermedad de Parkinson es efectiva. Evaluación funcional y análisis de complicaciones.

INTRODUCTION: Thanks to improvements in the medical treatment of Parkinson's disease (PD), the life expectancy of these patients has increased, but the overall outcome after total knee arthroplasty (TKA) is controversial. We aim to analyse a series of patients with PD, evaluating their clinical status, functional results, complications and survival rates after TKA. METHODS: We retrospectively studied 31 patients with PD operated between 2014-2020. The mean age was 71 years (SD±5.8). There were 16 female patients. The mean follow-up was 68.2 months (SD±36). We used the Knee Scoring System (KSS) and the Visual Analog Scale (VAS) for the functional evaluation. The Modified Hoehn and Yahr Scale was used to assess the severity of PD. All complications were recorded, and survival curves were performed. RESULTS: The mean postoperative KSS evaluation had an increase of 40 points [35 (SD±15) vs 75 (SD±15) (P<.001)]. The mean postoperative VAS decreased 5 points [8 (SD±2) vs 3 (SD±2) (P<.001)]. Thirteen patients reported being very satisfied, 13 were satisfied, and only 5 were poorly satisfied. Seven patients suffered surgical complications, and 4 patients had recurrent patellar instability. At a mean 68.2 months follow-up, the overall survival rate was 93.5%. When considering the secondary patellar resurfacing as the endpoint, the survival rate was 80.6%. CONCLUSIONS: In this study, TKA was associated with excellent functional outcomes in patients with PD. At a mean 68.2 months follow-up, TKA had excellent survivorship in the short term, with recurrent patellar instability as the most common complication. Even though these findings confirm the effectiveness of TKA in this population, a thorough clinical evaluation and multidisciplinary approach are needed to decrease the likelihood of complications.

Fracture of a triple-polished tapered cemented femoral stem at the Morse taper after metal-on-metal primary total hip arthroplasty.

Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.

Gait instability may indicate liner failure in patients with total hip arthroplasty. A report of three cases.

Total hip arthroplasty is one of the most common and successful orthopaedic procedures performed worldwide. Uncemented modular acetabular components and highly cross-linked polyethylene liners are the implants of choice for most arthroplasty surgeons. However, despite their well-known benefits, highly cross-linked polyethylene liners are not without complications, such as rim fracture, rupture and dissociation. We report three patients with gait instability and radiographic subluxation due to highly cross-linked polyethylene liner failures evidenced during stage one revision surgery. The three patients were symptoms free, with no new instability episodes, and the radiographs showed no evidence of implant loosening at the most recent follow-up. Although it is a rare complication, these three cases highlight the importance of suspecting and evaluating highly cross-linked polyethylene liner failures in patients referred for gait instability with no history of previous trauma.

Six-stage revision surgery of a triple periprosthetic joint infection due to a delayed diagnosis of a bilateral psoas abscess: a case report.

CASE: We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. CONCLUSION: Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.

Is hip arthroscopy useful in the treatment of borderline dysplasia?: a case-control study. / ¿Es útil la artroscopia de cadera para el tratamiento de la displasia limítrofe?: análisis de casos y controles.

INTRODUCTION: Since arthroscopy remains a controversial treatment of hip dysplasia, our objective was to analyse its clinical and radiological results in a cohort of patients with dysplasia and compare them to controls with femoroacetabular impingement (FAI). MATERIAL AND METHODS: We retrospectively analysed a series of patients who underwent hip arthroscopy for the treatment of labral pathology; 29 of them with borderline hip dysplasia and 197 with FAI, comparing reoperations and joint survival. The diagnosis of borderline dysplasia was made with a lateral centre-edge angle greater than 18° but less than 25°. The average follow-up was 43 months. We performed a multivariate regression analysis to evaluate the association of reoperations with different demographic, radiological and intraoperative variables. RESULTS: Seven complications were registered in the FAI group (1 medically treated superficial wound infection, 3 pudendal nerve paraesthesias, 1 deep vein thrombosis and 2 heterotopic ossifications) and none in the dysplasia group. While 5 patients from the FAI group required a new surgery, none of the dysplasia group was re-operated (p=.38). After adjusting for confounders, reoperation showed a very strong association with the finding of osteochondral lesions during index surgery, with a coefficient of .12 (p<.001, 95%CI=.06-.17). CONCLUSION: Hip arthroscopy was useful in the treatment of borderline dysplasia, without non-inferior survival compared to the FAI group. We suggest indicating it carefully in dysplasia cases, whenever the symptoms of femoroacetabular friction prevail over those of instability.